Vol 21, No 1 (2015)

Medirn orthopaedics

Do new and more expensive implants provide better outcomes in total hip arthroplasty?

Kovalenko A.N., Shubnyakov I.I., Tikhilov R.M., Cherny A.Z.


Total hip arthroplasty (THA) is one of the most successful surgeries in medical history. But rising demand in such procedures creates significant burden on national health systems all over the world so that researhers more often pay attention to economic impaction of THA. The use of new implants also increases a cost of arthroplasty. But it is a question whether new and more expensive implants could improve clinical outcomes. It became the purpose of our study. We studied available literature in Medline database about main trends of new hip endoprosthetic developments in previous decade and how they can impact to outcomes. Furthermore we studied our data of first revisions of domestic and import implants with comparison terms, structure and frequency of special revision implants using. According to our results new and expensive implants are not basic factor of reliable functioning of hip endoprosthesis.
Traumatology and Orthopedics of Russia. 2015;21(1):5-20
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Medium-term results of hip arthroplasty with ASR XL (DePuy)

Danilyak V.V., Vergay A.A., Kluchevskiy V.V., Molodov M.A.


The purpose - to identify factors affect on instability and to access the medium-term survivorship of metal-on-metal X-large heads total hip prostheses. Material and methods. From January 2007 March 2009 we performed 134 ASR XL head - Corail total hip arthroplasties in 119 patients. The medium-term results were studied in 94 (105 hips). Mean follow-up was 76±3 months. Radiological evaluation was carried out in standard views. Clinical and functional results were accessed with Harris Hip Score. We determined metal ions concentration in whole blood with atomic absorption spectrometry (AAS) and mass spectrometry in the induced coupled plasma (ICP-MS). Changes in periprosthetic tissues were studied at high field magnetic resonance imaging (MRI) with subsequent histological confirmation. “Gamma test” was applied for statistic analysis revision risk factors. Results. Medium-term survivorship of studied implants amounted to 85.5% (95% CI 78.7% to 92.3%). Average ions concentration in the whole blood of amounted to 3.2 ppb and 2.9 ppb foe Co and Cr respectively Specific risk factors of instability were gender (female), small size of the cups, and high angle of abduction (>45°). The main reason for revision was cup loosening (over 50%). Conclusions. Patients in this cohort are in a great danger of early aseptic loosening, especially in the presence of specific risk factors. So the annual monitoring is considered mandatory for them. The indications for revision surgery are not only the evident implant instability, but also the pathological changes in periprosthetic tissues associated with high ions level in whole blood.
Traumatology and Orthopedics of Russia. 2015;21(1):21-31
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Clinicoanatomic study of optimal arthroscopic approaches to the elbow

Kuznetsov I.A., Fomin N.F., Salikhov M.R., Zhabin G.I., Shulepov D.A., Bantser S.A.


The purpose: development and topographic substantiation of optimal arthroscopic approaches to the elbow, taking into account the location of the neurovascular structures in different functional positions. Material and methods: Anatomical relationships of elbow nerves and bony structures were studied by dissection of non-fixed anatomical material (6 elbow joints). To investigate the variant anatomy of the brachial artery, MRI in 23 patients were performed. In 10 patients the authors used ultrasound to study the topographic relationships of elbow nerve structures at different functional positions of the upper extremity Variability of the brachial artery deviation, depending on the angle of elbow flexion, was studied in six angiograms of non-fixed anatomical material. Statistical analysis was performed using Instant + and Past 306 software. Results: It was found that elbow flexion of 180°-90° moves the brachial artery away from the bones with a maximum distance from the humerus of 5 cm above the joint space. Distance increases from 23.5±3.1 mm to 23.9±3.1 mm. In 90° elbow flexion radial and median nerves are at the maximum distance from bony structures - 16.01±0.43 and 20.48±0.28 mm, respectively. Conclusion: These findings allowed justification of the conclusion that the lateral arthroscopic approaches to the elbow are the safest. It is possible to perform two lateral arthroscopic approaches: optical and instrumental, without conflict with major neurovascular structures. The optimal position for the surgery is 90° elbow flexion.
Traumatology and Orthopedics of Russia. 2015;21(1):32-41
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Comparative study of metacarpophalangeal joint arthroplasty effectiveness in patients with rheumatoid hand

Rodomanova L.A., Afanas’Yev A.O.


Objective - to determine the optimal implant for metacarpophalangeal joint arthroplasty in patients with rheumatoid hand. Materials and methods. 24 patients with rheumatoid hand were operated in Vreden Russian Research Institute of Traumatology and Orthopedics (St.-Petersburg, Russia). 37 MCPJ arthroplasties were performed with 129 implants of 3 types. First group consisted of 11 patients with 43 implanted NeuFlex “DePuy International Ltd.” silicone implants on 12 hands. Second group - 6 patients with 26 implants Daphne “TECRES S.p.A.” on 7 hands. Third group - 16 patients with 60 implants RM Finger “MATHYS AG Bettlach” on 17 hands. Criteria for treatment effectiveness were estimated taking into account hand function, complications and also relapse of deformation. We compared movement amplitude in MCP joins, angle of ulnar drift, strength of hand and also subjective assessment by patients with DASH. Results were fixed before surgery and 3, 6 and 12 months after. Results. Complications were recorded in I and II of patient groupsin 50% of cases:fracturesof components, dislocations of construction, relapse of ulnar drift. Complications in III group of patients were not detected. Range of motion and function improvement were increased in all groups (p>0,05), as well as strength of hand. But the most stable growth of hand strength was fixed only in III group (p<0,05). Relapse of ulnar drift occurred in I group of patients. Conclusion. RM Finger “MATHYS AG Bettlach” is more reliable for metacarpophalangeal joint arthroplasty since it provides stable long-term results of treatment.
Traumatology and Orthopedics of Russia. 2015;21(1):42-50
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Effect of rheumatoid arthritis drug therapy on results of large joint arthroplasty (preliminary report)

Akhtyamov I.F., Lapshina S.A., Gilmutdinov I.S., Myasoutova L.I.


Purpose: to evaluate the results of the knee and hip arthroplasty in patients with rheumatoid arthritis (RA) depending on baseline disease activity and received drug therapy. Materials and methods. Arthroplasty was performed in 48 patients (hip - 39 and knee - 9) with RA. The mean age was 49.5±15.82 years. Disease activity according to DAS28 - 4.41±1.83. All the patients received NSAIDs in stable doses. 26 (54.2%) patients received corticosteroids at a dose of 5-10 mg/day in terms of prednisolone, and 30 (62.5%) -basic antirheumatic drugs (DMARDs). Treatment was ongoing at the time of surgery and 6 months or more after it. Assessment of pain (VAS), disease activity (DAS28), quality of life (HAQ) were evaluated preoperatively, before discharge from hospital and 6 months after. Results. The pain (VAS) decreased by 34.2±19.1 mm in patients who received DMARDs and HAQ by 0.70±0.32 (p<0.05) compared with patients treated with corticosteroids without basic therapy (AVAS 24.2±18.2 mm, AHAQ = 0.46±0.31). Postoperative complications such as deep vein thrombosis and soft tissue infections are more likely in patients receiving steroid therapy. Conclusion. Arthroplasty is an effective method in improving the functional status, pain relief and it helps to reduce the rheumatoid arthritis activity. Surgery results in relation to the life were better in patients taking DMARDs. Steroids undoubtedly increase the risk of complications and decrease effectiveness of arthroplasty. It was recommended to reduce steroids dose during preparation of patient for surgery.
Traumatology and Orthopedics of Russia. 2015;21(1):51-57
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Tne stiffness of first-order and second-order modules assembled with extracortical clamp devices

Sabirov F.K., Solomin L.N.


The extracortical clamp device (ECD) is a tool used in external fixation which unlike the K-wires and half-pins don’t perforate cortical bone. The use of ECD is prospective for the treatment of periprosthetic femoral fractures and in the lengthening over nail and bone transport over nail. The data on the bench tests of the osteosynthesis rigidity by the external fixation first-order and second-order modules on the base of extracortical clamp devices are observed in the article. Materials and methods. The authors made 240 bench tests using torsional-vibration machine, Indicators measuring linear displacements with a scale of 0.01 mm, bone simulators («Sawbones»), calibrated load, Ilizarov’s apparatus и extracortical fixators. The statistical analysis was performed with use software «STATISTICA» (ver. 6.0). The data obtained are presented in graphs «Box and Whisker Plot». Results. Among the investigated variants of first-order modules the better results of osteosynthesis rigidity were found in the module based on two ECD inserted at angle 60 degrees to each other and at distance of 10 cm from each other. Among the investigated second-order modules, better results of osteosynthesis rigidity were found in the module based on two ECD inserted at an angle 60 degrees to each other at distance of 10 cm from each other. Conclusion. Thus the tested modules can be used in practice in assemblies of external fixation devices in periprosthetic fractures, lengthening and bone transport over the nail.
Traumatology and Orthopedics of Russia. 2015;21(1):58-65
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Case Reports

Arthroscopic treatment of secondary rotator cuff damage after shoulder hemiarthroplasty (case report)

Dokolin S.Y., Kuzmina V.I.


Anatomical shoulder arthroplasty is an effective treatment for patients with primary deforming arthritis, rheumatoid arthritis and aseptic necrosis of the humeral head. However this kind of surgery is associated with high risk of complications, and within five-year follow-up the incidence of complications increases. The authors described a clinical case illustrating one of these complications - secondary rotator cuff damage after shoulder hemiarthroplasty. The tear was verified using radiological methods and arthroscopy. They performed arthroscopic rotator cuff repair using suture anchors in order to alleviate pain and preserve shoulder functions. If there are no signs of endoprosthetic instability and coracoacromial ligament is preserved, arthroscopic treatment of such damages extends the time of limb function preserving the endoprosthesis. Patients should not raise their arms above the horizontal level.
Traumatology and Orthopedics of Russia. 2015;21(1):83-89
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Structural reorganization of the knee joint cartilage and synovium during diaphyseal femoral fracture management using intramedullary locked nails ^perime^al and morphological study)

Emanov A.A., Stupina T.A., Antonov N.I.


The purpose - to study structural changes in knee articular cartilage and synovial membrane during locking intramedullary osteosynthesis of femoral fractures. Material and methods. The study tested structural changes in the articular cartilage of the femoral condyles and synovium during femoral fracture repair under the conditions of intramedullary locked nailing. Transverse diaphyseal femoral fractures were modeled in 12 adult mongrel dogs. Synovitis severity was assessed with a V. Krenn scale. Wilcoxon Test was used for testing hypothesis. Results. In the first group (n = 6) fractures were fixed with locked intramedullary nails ILoc (Biomedtrix, USA), while the same type of fixation in group 2 (n = 6) was performed on 4th day postoperatively after reduction by skeletal traction. It was revealed that in the first group a unified medullary cavity was seen by day 70 and the cortical layer at the fracture site approximated to the condition of the uninjured bone in intensity of bone formation and thickness. These featured were observed in the second group only by day 100. The histological study showed that the structure of the femoral condyle articular cartilage was regular in the first group but its changes were reduced thickness and reduced volumetric density of chondrocytes that might result due to disturbed trophical condition. In the second group the articular cartilage fibres tended to disintegrate on the surface that was accompanied by disturbed integrity of the basophil line and penetration of the vessels into the cartilage. Moreover, the cartilage destruction progressed as the experiment continued and chondrocyte proliferation sharply decreased. Synovitis was considerably expressed. The data obtained in the second group proved high risk of developing osteoarthrosis.
Traumatology and Orthopedics of Russia. 2015;21(1):66-73
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Surgical treatment of children with scars on the lower leg and in the area of Achilles tendon using expander dermatension

Filippova O.V., Baindurashvili A.G., Afonichev K.A., Vashetko R.V.


Treatment of scar deformities of shin and ankle is traditionally a challenge due to significant functional load to the segment and the surface location of the Achilles tendon. Published data indicates that the use of expander dermotension of shin is not widespread and poorly covered in the literature [6]. Available data in the literature devoted to the expander dermotension of shin, are characterized by individual observations. There are no clear guidelines for size selection of the expander, for the protocol of its filling and postoperative regime. The purpose was to study the peculiarities of tissue dermotension of shin and development of recommendations for the use of this method to recover the full skin of shin and area of the Achilles tendon. Materials and Methods. Full restoration of the skin on the leg in the area of the Achilles tendon using tissue dermotension was performed in 24 patients in the clinic of Turner Scientific and Research Institute for Children’s Orthopedics from 2009 to 2014. To perform dermotension we used tissue expanders Eurosilicone (France), st. reg. № FSZ 2010/07171 from 09.06.2010; atraumatic suture material. Results. Complications amounted to 12.5% of all observations, and included: migration of port expander, marginal necrosis on line surgical suture and transient swelling of the foot. Efficacy of treatment was evaluated according to the following criteria: 1) the restoration of full cover in the region of the scar deformation; 2) elimination of adhesions, restore slip anatomical structures; 3) the increase of the amplitude of motion of the ankle joint. All patients achieved clinical improvement 2-3 criteria that considered a good result. Complications did not have a significant impact on the final result of the treatment. Conclusions: 1. Expandera dermatensia is an effective way to full recovery of the skin on the calf and the Achilles tendon. 2. Capsule forming around the expander and part of the flap, which helps eliminate adhesions and restoring slip anatomical structures and to increase range of motion in the ankle joint.
Traumatology and Orthopedics of Russia. 2015;21(1):74-82
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A new method of non-free plasty with axial medial flap 90 of the foot

Minasov B.S., Biktasheva E.M., Valeev M.M.


The article describes of non-free plasty with axial medial flap of the foot on the lateral surface of its rear section to close large defects of soft tissues. The method was used in clinical practice in nine patients who had contraindications to the use of free composite grafts with the imposition of microvascular anastomoses (damage dorsal artery of the foot, post-thrombotic syndrome, stenosing atherosclerosis of lower limb arteries). The causes of soft tissue defects were direct traumas (2 cases) and complications after osteosynthesis (7 cases). The sizes of the flaps amounted to from 3.0х2.0 cm by 4.0х7.0 cm. In 7 cases the authors used the skin-fascial flap, in 2 patients the composite graft included also the fragment of the muscle belly abducting I toe. All autografts completely survived. In two cases the donor wounds healed by secondary intention, which did not affect the basic function of the operated limb. Functional and aesthetic results are fully satisfied patients.

Traumatology and Orthopedics of Russia. 2015;21(1):90-94
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The modern approaches to the treatment of chronic posterior instability of the knee (review)

Kuznetsov I.A., Fomin N.F., Shulepov D.A., Salikhov M.R.


The history of surgical treatment of the posterior cruciate ligament injuries spanned more than 100 years. The first publications describing knee surgical stabilization have appeared in the early 20th century Until the early 1980’s there were several original methods of surgical treatment of posterior cruciate ligament injury including a dynamic stabilization with plasty by local tissues. Since the 1980’s with the development of arthroscopy the approach to surgical treatment of knee ligament injuries has changed. The authors discussed both advantages and disadvantages of different techniques of arthroscopic posterior cruciate ligament plasty. This review presents different views on arthroscopic repair of posterior cruciate ligament at present time.
Traumatology and Orthopedics of Russia. 2015;21(1):95-105
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Current principles and trends of using axial pattern flaps in reconstructive surgery of the extremities

Kutyanov D.I., Rodomanova L.A.


On the basis of published data, we identified and analyzed current principles and trends of using axial pattern tissue complexes in patients with limb defects, depending on the nature and localization of the defect, and also objectives of reconstructive surgery. Today, there are three closely related trends. The most important one is to reduce injury caused by intervention; this results in using non-free island flaps instead of the widespread use of free perfused tissue complexes. The second trend is aimed at obtaining the most favorable functional results in treating defects of the covering structures relative to similar defects of bones and muscle-tendon units. The third trend is minimizing the negative aesthetic results.
Traumatology and Orthopedics of Russia. 2015;21(1):106-115
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Modern aspects of diagnostic and surgical treatment of patients with hip periprosthetic infection (review)

Pavlov V.V., Sadovoy M.A., Prokhorenko V.M.


Hip replacement is widespread surgical procedure in orthopedic surgery. Nether the less, the main and most costly problems in replacement of large joints with socially significant losses are infectious complications. The aim of this review is to analyze available data dedicated to infectious complications in orthopedy and to extract basic principles of diagnostics and treatment of the hip joint implant infection. It could be stated that early diagnostics and precise identification of causative agent, including evaluation of the microbiological, clinical, diagnostic imaging, immunological, histological and biochemical parameters, and also an adequate to the collected diagnostic data choice of surgical tactics and antibiotic treatment are the important components of successful treatment of periprosthetic infection.
Traumatology and Orthopedics of Russia. 2015;21(1):116-128
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Systemic toxisity of local anesthethics during regional anesthesia in orthopedics and traumatology

Koryachkin V.A., Chupris V.G., Cherny A.Z., Kasarin V.S., Lis’Kov M.A., Malevich G.M., Maltsev M.P.


There are cases of accidental intravascular injection of local anesthetic when performing regional anesthesia. The frequency of this complication was 0.28 per 1,000. We describe the clinical manifestations and the basic principles of the treatment of local anesthetics systemic toxicity. Discussed in detail the mechanism of action of fat emulsion and the protocol of lipid resuscitation Accidental intravascular injection of local anesthetics. The mechanism of action of fat emulsion and the protocol of lipidrescue accidental intravascular injection of local anesthetics was discussed.

Traumatology and Orthopedics of Russia. 2015;21(1):129-135
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Data of knee arthroplasty register of Vreden Russian Research Institute of Traumatology and Orthopedics for period 2011-2013

Kornilov N.N., Kulyaba T.A., Fil A.S., Muravyeva Y.V.


The knee arthroplasty register was established in Vreden Russian Research Institute of Traumatology and Orthopedics on 01.01.2011 and during the following 3 years the data about 6530 primary (91,7%) and revision (8,3%) cases were collected. The average age of patients was 62,72 ±11,5 years with the prevalence of women both in primary (80%) and revision (70%) arthroplasty cohorts. The main group consisted from the patients with knee osteoarthritis (92%) with annual growth of the obese. Total cemented knee replacement without patella resurfacing was the most popular type of primary arthroplasty (96%) with the prevalence of PCL retaining implants (62,13±3,84%). Despite annual decrease of revisions due to infection they predominate under aseptic cases: in 2011 - 64,7% and 35,3%, in 2012 - 62,8% и 37,2% , in 2013 - 53,1% and 46,9% accordingly. The main reason for non-infected revision TKA was implant loosening (17%). This is the first attempt to describe the trends in knee arthroplasty based on data from register of Russian Research Institute of Traumatology and Orthopedics. It’s structure allows to perform multifactorial analysis of knee replacement surgeries and in the future to evaluate implants survival rate.
Traumatology and Orthopedics of Russia. 2015;21(1):136-151
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Letters to Editor

Comment to the article «To the question of the immobilization after reduction of primary traumatic shoulder dislocation (review)» by VA Aslanov, RP Matveev

Sereda A.P.



Traumatology and Orthopedics of Russia. 2015;21(1):152-153
pages 152-153 views

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