Vol 32, No 1 (2026)

Background. Despite the proven advantages of unicompartmental knee arthroplasty (UKA) over total knee arthroplasty for isolated single-compartment pathology, the proportion of UKA in Russia remains extremely low (less than 6%), which is due to a lack of objective information about long-term functional outcomes and factors influencing patient satisfaction.

The aim of the study — to evaluate functional outcomes and patient satisfaction following unicompartmental knee arthroplasty, as well as to determine the impact of demographic factors and obesity on clinical outcomes and subjective pain perception during various activities of daily living.

Methods. A retrospective analysis was conducted on data from 302 patients who underwent UKA between 2011 and 2022. Patient satisfaction was assessed using a 5-point Rasch scale, and pain syndrome was measured using the Likert scale across 12 types of activities. Two integral indicators were calculated: the pain index (PI) and the pain-free percentage (PFP).

Results. Overall satisfaction was high across the sample (median score — 5). Women exhibited a higher PI (1.30±0.12) than men (0.74±0.17), although the differences were not significant. The most painful activities for women were rising from a low object, walking on uneven surfaces, and climbing stairs, while for men they were prolonged standing, household chores, and rising from a low object. No significant differences were found between age groups or BMI categories. The percentage of patients with high satisfaction (scores of 4-5) gradually increased with age, although these differences did not reach statistical significance.

Conclusion. Unicompartmental knee arthroplasty has demonstrated high effectiveness in achieving patient satisfaction (92.1%) and restoring functional mobility, regardless of sex, age, or BMI, over a 12-year observation period.

Background. 3D printing technology has found widespread use in the production of custom-made and mass-produced acetabular components. Since the end of 2022, a new fully porous acetabular component with multiple screw holes and cemented liner fixation has been available.

Research questions. In which clinical scenarios were the fully porous acetabular components used, and with which friction units? Which additional elements were used to achieve reliable primary fixation? What are the short-term survival rates of these implants and the functional outcomes of patients?

Methods. The new component was used in 106 patients between October 2023 and December 2024. There were 55 (51.9%) women and 51 (48.1%) men. The average age was 60.7 years. In 11 (10.4%) cases, implantation was performed in complex cases of primary hip arthroplasty; in 48 (45.3%) cases, during aseptic revisions; and in 47 (44.3%) cases, during the second stage of infection-related revision. In all cases, screws were used for fixation, the number of which ranged from 2 to 10, with an average of 5.5. In 38 (35.8%) cases, acetabular components were combined with augments and/or cup-cage systems. In 47 (44.3%) cases, dual mobility cement fixation systems were used as a friction unit; in the remaining cases, cemented polyethylene liners were used.

Results. The mean follow-up period was 14.1 months (range, 9-23 months). There were 18 (17.0%) complications, 10 of which required repeat revisions. Complications included 6 (5.7%) cases of infection, 5 (4.7%) cases of recurrent dislocations, 3 patients developing sciatic neuropathy, 2 cases of femoral component loosening, and 2 cases of periprosthetic fractures. No aseptic loosening of the acetabular component was observed.

Conclusions. The advantages of the new acetabular component include the possibility of extended screw fixation and the use of different bearing surfaces, including dual mobility. This ensures reliable primary fixation and reduces the risk of recurrent dislocations. The use of a fully porous titanium acetabular cup with a cemented liner in complex primary and revision hip arthroplasty has demonstrated good radiographic results and early survival with a minimum follow-up of 9 months.

Background. Radical surgical debridement is the most important condition for the successful treatment of patients with chronic osteomyelitis. However, since even the most meticulous debridement cannot guarantee complete eradication of the pathogen, local antibacterial therapy becomes of key importance. This underscores an urgent clinical need for the development of an osteoplastic biodegradable material with prolonged antimicrobial activity. One of the most promising options is a purified allogeneic bone-based material.

The aim of the study — to perform a comparative evaluation of the duration of the antibacterial activity of allografts impregnated with different antibiotics against Gram-positive and Gram-negative bacteria.

Methods. Purified and delipidized bone allografts measuring 5×5×5 mm were prepared according to the procedure developed by the authors. The bone blocks were impregnated with antibacterial agents with varying activity spectra: vancomycin, aztreonam, meropenem, and fosfomycin. The presence and duration of antibacterial activity of the obtained samples were determined against reference bacterial strains depending on the drug’s spectrum of activity by applying a 24-hour incubation solution containing the samples to the surface of a bacterial lawn. The data were analyzed using GraphPad Prism 9.0.

Results. Applied standard vacuum impregnation protocol ensured reproducible saturation of bone tissue with antibiotics. The greatest increase in mass was observed after impregnation with aztreonam, whereas the smallest increase was noted after impregnation with fosfomycin. Vancomycin-impregnated blocks were most active against methicillin-sensitive and methicillin-resistant S. aureus. Meropenem-impregnated blocks were effective for 4 days against K. pneumoniae. Impregnation with aztreonam provided antibacterial activity against K. pneumoniae for up to 6 days. Fosfomycin-impregnated blocks were active against Gram-negative pathogens for 6 days.

Conclusion. The developed technique was shown to ensure the antibiotic loading of the bone substitute material and drug release over several days, with the most prolonged effect observed following impregnation with vancomycin and fosfomycin. Further optimization of osteoplastic materials processing methods is needed, as well as testing other potential antimicrobial agents in combination with antibiotics to overcome potential pathogen resistance.

Background. At present, the issues surrounding the surgical treatment of combined deformity of the first and fifth metatarsal bones, particularly when accompanied by cerebrovascular disorders of the lower extremities, remain unresolved.

The aim of the study — to compare the outcomes of different surgical techniques used for the treatment of the fifth metatarsal bone in patients with combined deformity of the first and fifth metatarsal bones accompanied by cerebrovascular disorders of the lower extremities.

Methods. This prospective randomized monocentric cohort study enrolled 70 female patients with combined deformities of the first and fifth metatarsal bones accompanied by cerebrovascular disorders of the lower extremities. Correction of the fifth metatarsal deformity was achieved through minimally invasive closed osteotomies employing two different techniques. Group I included 33 (47.1%) patients treated with a minimally invasive free-hand burring technique. Group II, consisting of 37 (52.9%) patients, was treated using a specifically developed universal guiding device. In all patients, first metatarsal deformity correction was achieved through combined scarf and Akin osteotomy of the proximal phalanx of the hallux. The duration of surgery, as well as the number of intraoperative X-rays taken and the radiation exposure, were assessed. At 6 months post-surgery, we evaluated the type and incidence of postoperative complications, pain dynamics, functional outcomes, and the degree of deformity correction according to radiographic data.

Results. No statistically significant difference in operative time was found between the groups: 47.3±8.5 mins in Group I versus 51.5±9.1 mins in Group II. However, Group II demonstrated a significant reduction both in the number of intraoperative X-rays and radiation exposure: 6-8 X-rays per surgery with a mean radiation dose of 0.1-0.3 mGy, whereas Group I required up to 17-21 X-rays with a mean radiation dose of 0.4-0.6 mGy (p <  0.001). The 6-month follow-up revealed a significant reduction in pain intensity according to the VAS FA scale (scores: 8 [8; 9] in Group I versus 9 [8; 10] in Group II, p <  0.001) and enhanced functional status according to the AOFAS scale (scores: 72 [67; 85] in Group I versus 74 [62; 87] in Group II, p <  0.001) for both groups.

Conclusion. Minimally invasive osteotomies proved to be a highly effective and safe treatment modality for correcting combined deformities of the first and fifth metatarsal bones in patients with concomitant vascular and endocrine pathology. While the functional outcomes and postoperative complication rates were comparable between the two minimally invasive osteotomy techniques for the fifth metatarsal bone, the use of the developed universal guiding device significantly decreased the number of intraoperative X-rays taken and the radiation exposure.

Background. Pathology of the long head of the biceps tendon (LHBT) includes dislocation/subluxation, tendinitis, and tendon rupture and is frequently associated with rotator cuff injuries. Surgical treatment options include tenotomy or tenodesis. Although the choice of the tenodesis level for the LHBT is largely subjective, the tenodesis site affects not only functional outcomes but also the risk of pathological fracture of the humerus.

The aim of the study — to evaluate the influence of drill hole diameter for the suprapectoral tenodesis of the long head of the biceps on the risk of the pathological fractures of the proximal humerus using finite element analysis.

Methods. A three-dimensional model of the humerus, including cortical and trabecular bone components, was constructed based on CT data of a 64-year-old patient. Finite element analysis (ANSYS; SOLID185 elements, average element size ~0.7 mm) included the following scenarios: (1) a fall with the arm abducted at 45°, (2) external and internal rotational loading of the humerus with kinematic rotation of 3°-6° in both directions, and (3) comparative stress distribution analysis in intact bone (no drill hole) and after creation of through holes. An intact humerus was compared with humeri containing suprapectoral through holes of d = 5.0/1.5 mm (anchor fixation) and d = 7.0/2.4 mm (screw fixation).

Results. During a fall on an abducted arm, peak tensile stresses were localized in the region of the surgical neck on the medial surface of the humerus, while the bicipital groove and suprapectoral region remained outside the zone of critical stress. During rotational loading, the presence of a drill hole shifted the maximum shear stress toward the drilling zone. In intact bone, the critical external rotation angle decreased from 6° to 5° after drilling. In bone with reduced mineral density, it decreased from 6° to 3°. For internal rotation, the critical angle decreased from 5° to 4°. The influence of drill hole diameter was minimal, accounting for only a 1-2% increase in stress.

Conclusions. This study identified critical patterns in how bone perforation affects the stress–strain state of the humerus. Bone strength was primarily dependent on the presence of perforation rather than on the drill hole diameter within the investigated range, and increasing the diameter from 5 to 7 mm resulted in only a minor increase in stress (1-2%). These findings suggest that the optimal strategy is to place the drill hole in the proximal humerus, where critical shear stress concentrations are not initially present.

Background. The increasing volume of clinical information under conditions of limited time and human resources places a substantial burden on medical personnel and increases the risk of errors in routine tasks, including the completion of medical records. Automation of medical documentation using artificial intelligence (AI) technologies represents a promising approach to reducing time costs and improving the quality of clinical data management.

The aim of the study — to evaluate the impact of an AI-assisted automated system on the clinical workload of an orthopedic trauma surgeon and the quality of medical documentation.

Methods. A retrospective comparative before-after study was conducted. An automated system integrating automatic speech recognition (ASR), natural language processing (NLP), and generative text modules was implemented in the clinical workflow. Three orthopedic trauma surgeons with more than 10 years of professional experience participated in the study. Data from 480 electronic medical records of patients hospitalized for primary total hip arthroplasty were analyzed (240 before and 240 after system implementation). The following parameters were evaluated: time required for completing medical records, frequency of record returns for correction by the quality control department, subjective workload assessed using the adapted Russian version of the NASA-TLX, and physician satisfaction assessed using a 5-point Likert scale.

Results. After system implementation, the average time required to complete a full medical record decreased from 92.4±14.7 to 48.1±11.2 minutes (p <  0.001). The proportion of records returned for revision decreased from 18.3% to 6.7% (p = 0.004). The mean NASA-TLX score reflecting subjective workload decreased from 67.5±8.2 to 48.9±7.1 (p = 0.002). Physician satisfaction with the system averaged 4.3 out of 5.0 points on the Likert scale.

Conclusion. Implementation of an automated system incorporating artificial intelligence technologies significantly reduces the time required for medical documentation, improves its quality, and decreases the cognitive workload of physicians. These findings support the potential of AI-based tools to optimize clinical workflows and improve efficiency in orthopedic practice.

Background. Augmented reality (AR) technology represents a fundamentally new visualization method in which computer-generated information (fracture imaging) is projected onto real-world objects (the patient’s limb). The potential use of AR methods may significantly improve the accuracy of surgical approach placement, the quality of reduction, and the overall safety of surgical interventions.

The aim of the study — to present our experience of using augmented reality in clinical practice in the treatment of intra-articular distal tibial fractures.

Methods. In this retrospective cohort study, we analyzed the use of AR technology with the MS HoloLens smart glasses and the Voka Trauma Surgery Assistant software. The technology was applied in the treatment of 20 patients (21 injured limbs) with intra-articular distal tibial fractures (types 43B and 43C according to the AO/OTA classification). We assessed the time required to use the system during preoperative planning and intraoperatively, the accuracy of surgical approach relative to the target fracture line, the quality of fracture reduction, the incidence of postoperative complications, and long-term treatment outcomes with a follow-up period of at least one year after surgery.

Results. The time required for data upload to the MS HoloLens headset and preoperative planning using the device comprised Me = 50.0 minutes [Q₁ — 45.0; Q₃ — 60.0], depending on model size and fracture complexity. The duration of the intraoperative use of the MS HoloLens ranged from 3 to 10 minutes (5.6±1.9). The accuracy of targeting the fracture line was rated as excellent or good in 86% of cases and satisfactory in 14%. The achieved quality of fracture reduction was assessed as good in 18 (86%) cases and satisfactory in three (14%) cases. There were no cases of deep infection; superficial infection was observed in 2 cases. Impaired bone union was identified in three cases: one case of delayed union and two cases of non-union requiring bone grafting and re-operation. Revision surgical procedures were required in four (19%) patients.

Conclusion. The clinical and radiological outcomes obtained in our study are generally consistent with the data reported in the literature regarding complication rates and functional treatment results, which allows us to draw a preliminary conclusion about the safety of augmented reality. Further direct comparative studies are required to determine the clinical efficacy of this technology.

Background. Medical registries play an important role in modern evidence-based medicine, providing objective data on the comparative effectiveness of various treatment methods and their long-term outcomes. Since 2023, Vreden National Medical Research Center of Traumatology and Orthopedics has maintained a local registry of knee cruciate ligament reconstruction maintained, the performance of which requires a detailed study.

The aim of the study — to analyze main trends in primary anterior cruciate ligament reconstruction using data from the local registry of the Vreden National Medical Research Center of Traumatology and Orthopedics, and to compare the obtained results with those from foreign registries.

Methods. The study included data on 850 patients from the knee cruciate ligament registry who underwent primary anterior cruciate ligament (ACL) reconstruction. To compare the obtained results with global data, official reports and articles containing information on the work of leading foreign ACL reconstruction registries — Denmark, Sweden, Norway, the United Kingdom, the United States (Kaiser Permanente), and New Zealand — were reviewed.

Results. The mean patient age was 35±9 years [23.6; 35.1], with a pronounced predominance of males within the cohort (71.7%). Regarding the distribution of graft types, a slight preference for autografts was observed (52.9%). Among the allografts utilized, the tibialis posterior tendon was overwhelmingly preferred, accounting for 81.6% of all allografts. Concomitant meniscal injuries were diagnosed in 69.2% of cases. Concerning surgical technique, the transtibial approach was the most frequently employed, utilized in 34.6% of cases. The data on the surgical technique were missing from the registry for 16.8% of cases. An 8 mm graft diameter was the most commonly used size for drilling both the femoral (45.0%) and tibial (46.4%) tunnels. For both the transtibial and anteromedial techniques, the primary method of fixation was a “button — screw” combination, employed in 64.0% and 60.9% of cases, respectively.

Conclusion. The present study has demonstrated the potentially high informational value of the local registry as a tool for analyzing various aspects of primary anterior cruciate ligament reconstruction. However, a direct comparison with foreign data appears challenging due to the substantial difference in the sample size between our data and those of the large foreign anterior cruciate ligament reconstruction registries.

The aim of this meta-analysis — to compare clinical outcomes and complications of the reconstruction of extensive long-bone defects of the limbs of various etiologies in patients older than 18 years using the Masquelet technique, the Ilizarov bone transport, and reconstructive procedures with vascularized bone flaps.

Methods. Publications were searched in the eLIBRARY, PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases for the period 2015–2025. Randomized controlled trials and cohort studies addressing the reconstruction of extensive bone defects of the limbs using different techniques (the Masquelet technique (MT), bone transport (BT), and free vascularized flaps (FVF), particulary the fibular graft) were included in the analysis.

Results. Nine publications involving a total of 375 patients were included in the meta-analysis to assess the effectiveness and safety of the techniques. The majority of cases involved long bones of the lower limbs (n = 332; 87%), most commonly the tibia (n = 284; 74%), followed by the femur (n = 48; 13%). Among upper limb injuries, extensive bone defects of the forearm were reported in 44 cases (12%) and of the humerus in 4 cases (1%). The overall duration of fixation did not differ significantly between MT and FVF groups, nor between MT and BT groups (p = 0.76 and p = 0.40, respectively). The proportion of patients achieving complete bone union without additional surgical interventions was significantly higher with BT compared to MT (86% vs. 61%, p = 0.02). The analysis of surgical site infection (SSI) rates revealed the following patterns: the proportion of patients with superficial SSI was significantly lower with MT compared to BT (11% vs. 23%, p = 0.0004). Conversely, the incidence of deep SSI was significantly higher with MT compared to BT (15% vs. 8%, p = 0.04). No statistically significant differences were found regarding nonunion rates or the conversion of surgical treatment to amputation. The proportion of patients with excellent or good outcomes according to the ASAMI score was 85% for MT and 71% for BT; however, the difference was not statistically significant (p = 0.48).

Conclusion. The systematic literature review confirmed the effectiveness of all three methods: the Masquelet technique, the Ilizarov bone transport, and free vascularized flaps. The meta-analysis did not reveal a significant advantage of any single method in terms of fixation time or time to union; however, distinct safety profiles were identified and should be considered when selecting the surgical strategy. When choosing a technique for the reconstruction of large segmental bone defects, it is essential to take into account the defect location and length, soft tissue status, the presence and activity of infection, as well as individual patient characteristics, particularly treatment adherence and expectations regarding the quality of life.

This article presents the Universal Long Bone Defect Classification (ULBDC), developed for the standardized description of bone defects, selection of treatment strategy, and assessment of reconstructive outcomes. The current paper focuses on the part of the classification dedicated to diaphyseal defects. The system is based on AO/OTA principles and uses an alphanumeric hierarchical code reflecting localization (bone and segment) and defect morphology (type, group, subgroup, specification) according to the principle “from simple to complex.” To ensure standardized reporting, a unified terminology is proposed to provide precise morphological assessment of bone defects. The following terms are introduced: anticipated bone defect (BDa), cortical bone defect (BDc), and segmental bone defect (BDs). The classification is based on key morphological parameters, including bone integrity (Bi) and defect dimensions (length and width) relative to bone diameter (Bd). For segmental defects, particular attention is paid to shortening (Sh) and diastasis (D). Three types of diaphyseal defects are described: Type A — defects with preserved bone integrity (cortical and anticipated defects), Type B — non-segmental defects (cortical defects with disrupted bone integrity), and Type C — segmental bone defects. The hierarchical structure reflects increasing reconstructive complexity and prognostic severity. The possibility of transforming more complex defects into less complex ones through specific surgical strategies is demonstrated, highlighting the algorithmic value of the system. The ULBDC standardizes terminology, facilitates professional communication, and provides a foundation for the harmonization of clinical research. Despite its relative complexity, the classification demonstrates high reproducibility and practical relevance.