卷 28, 编号 1 (2022)

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.

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.

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.

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.

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.

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.

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.

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.

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.