卷 31, 编号 1 (2025)

The aim of the study was to determine the factors influencing functional outcomes and the likelihood of mechanical and infectious complications in patients with tumor involvement of the distal femur who underwent primary oncological knee arthroplasty.

Methods. We analyzed the treatment results of 227 patients who underwent primary oncological knee arthroplasty for tumor involvement of the distal femur between 2003 and 2018. Functional outcomes were assessed using the MSTS scale at the 12-month follow-up, while mechanical and infectious complications were evaluated according to the ISOLS classification. We also examined the factors affecting these outcomes.

Results. Various types of complications occurred after an average period of 70.5 months in 70 (30.8%) patients: infection (type IV) — 16 cases (7.1%); prosthesis failure (type III) — 13 (5.7%); instability of prosthetic components (type II) — 41 (18.1%). Active drainage did not affect the risk of infectious complications but significantly reduced postoperative hospital stay (p<0.001). Patients weighing more than 90 kg had a statistically significant increase in the risk of construct failure (p = 0.044). The use of rotating platform prostheses significantly reduced the risk of component failure (p = 0.016). When anatomical femoral stems and rotating platform prostheses were used, there was a significant reduction in the risks of component instability (p<0.001). The type of fixation did not increase the risk of mechanical complications (p = 0.860). Utilization of a thin cement mantle decreased the risk of prosthesis instability by 5.1 times compared to standard cementation techniques, with statistically significant differences in odds ratios. The median function of the knee joint, as measured by the MSTS scale, was 80%. Patients operated through the subvastus approach demonstrated the best joint function (p<0.001). At the 60-month follow-up, overall prosthesis survival rates ranged from 80 to 100%. However, at 125 months, the leading prostheses were Stryker (92.9%), Mutars (71.8%), and Biomet (69.1%).

Conclusions. Rotating-hinge endoprostheses showed optimal performance in reducing the risks of mechanical complications and increasing a construct lifespan. It is essential to use anatomically shaped stems when installing the femoral component. The choice of fixation method does not influence survival rate or stability of the component. It does, however, allow surgeons to take an individualized approach based on the patient’s weight, age, and bone condition. The medial subvastus approach offers the most favorable conditions for restoring knee joint function.

Background. In recent decades, interest in proximal interphalangeal joint (PIPJ) arthroplasty has significantly increased around the world. At the same time, a growing number of operations entail an increase in the number of reinterventions.

The aim of the study — to determine the causes and evaluate the outcomes of revision interventions for proximal interphalangeal joint arthroplasty based on the data from a federal center for trauma and orthopedics.

Methods. We analyzed gender and age distribution of patients, the number of revisions, possible causes of implant failure, its localization and type, survival rate of the construct, surgical approaches. The study covers a 15-year period.

Results. Among 95 performed primary PIPJ arthroplasties, 15 (15.8%) cases of failure were observed in 14 patients. There was 1 periprosthetic fracture; 2 cases of implant fracture; instability of implant components — 12 cases associated with injury, increased physical activity and other causative factors. The maximum failure rate was detected in the II finger (31.6% of the number of initially implanted prostheses). After primary arthroplasty, instability was most often observed in hinged implants (SBI D.G.T. PIP joint implant and the RM Finger Mathys). The option for reintervention in 2 (16.7%) cases was PIPJ arthrodesis, in 11 (83.3%) — revision arthroplasty.

Conclusions. Despite the significant (15.8%) rate of adverse outcomes after proximal interphalangeal joint arthroplasty, most frequently caused by implant instability, the survival rate of the implants reaches up to 10 years in some cases and depends both on the type of prosthesis and the patient’s occupation. Overall, revision proximal interphalangeal joint arthroplasty allows for joint mobility preservation and statistically significantly reduces pain.

Background. The generally accepted method of treating complex radial head fractures is arthroplasty. At the present stage, there is a variety of prosthetic designs, in production of which statistically averaged morphometric parameters are used. The anthropometric features of patients are not taken into account.

The aim of the study — to compare the morphometric parameters of the proximal radius obtained using computed tomography and computer modeling.

Methods. The study used the radiological method of examination and the computer modeling method. The study material was a database of DICOM format computer tomograms of the right and left elbow joints of 137 people (66 males, 71 females). Their age ranged from 40 to 70 years, without signs of musculoskeletal system pathology. Computer tomograms were analyzed using the RadiAnt DICOM Viewer program. Computer modeling was carried out through the ITK-SNAP program (GNU General Public License version 3.0 — GPLv3), with further processing of the obtained model using the developed software method.

Results. Comparison of the morphometric parameters of the radial head obtained using the developed computer modeling program and the morphometric parameters of a standard computed tomogram showed their identity.

Conclusion. The presented software program “Automated determination of bone morphometric parameters” will enable to model the radial head prosthesis on the basis of indicators of computer tomograms, taking into account the individual structural features of the patient’s radius.

Background. The implantation of an antimicrobial spacer is widely used in the comprehensive treatment of periprosthetic joint infection (PJI). Most commonly, bone cement is additionally impregnated with vancomycin, which is active only against Gram-positive bacteria. However, there is a global increase in Gram-negative bacterial resistance to most antibiotics, necessitating the development of new approaches to overcome this resistance, including in the context of local antibacterial therapy.

The aim of the study was to determine the duration of antimicrobial activity and the mechanical properties of gentamicin-containing bone cement samples additionally impregnated with the combinations of highly dispersed silver (HD-Ag) and various antibiotics.

Methods. Control samples were prepared using the commercial polymethylmethacrylate-based bone cement DePuy CMW 3 Gentamicin (DePuy Synthes), which contains 4.22% gentamicin. Additionally, six experimental samples with different combinations of antimicrobial agents were prepared and tested. Antimicrobial activity (AMA) was assessed against S. aureus (MSSA, MRSA), K. pneumoniae, and P. aeruginosa. The mechanical properties of the most effective samples were evaluated in comparison with the control samples. Statistical analysis was performed using the Past 4 software system.

Results. The control samples of commercial bone cement demonstrated the shortest duration of activity against MSSA (7 days) and showed no activity against MRSA or Gram-negative bacteria. The addition of 10 wt% fosfomycin and HD-Ag to the bone cement (BC 1) tripled the AMA duration against MSSA, K. pneumoniae, and P. aeruginosa. The addition of 5 wt% vancomycin to BC 1 (BC 2) extended the AMA duration against Gram-negative bacteria to 14-16 days and against Staphylococcus spp. to 4 weeks. The highest activity against Gram-negative bacteria was observed in samples containing HD-Ag and 10 wt% aztreonam (BC 5 and BC 6), whose mechanical properties did not significantly differ from the control samples.

Conclusion. Combinations containing HD-Ag, vancomycin, fosfomycin, and aztreonam demonstrated prolonged antimicrobial activity. This may improve the effectiveness of the debridement stage in two-stage revision arthroplasty for hip periprosthetic joint infection, making these combinations promising for clinical application.

Background. Ballet dancers have peculiarities in the morphology of the hip joints, which is determined by their professional activities. Therefore, they are more susceptible to the development of pathological conditions of joints, which often present a specific clinical picture.

The aim is to demonstrate a rare structural damage to the hip joint capsule and iliofemoral ligament in a ballet dancer.

Case description. The patient is a 32-year-old professional ballet dancer. She noted pain and limited range of motion in the right hip joint during her dance classes. Radiologic examination methods identified minimal anatomical features characteristic of femoroacetabular impingement, and damages to the acetabular labrum and structures of the anterior joint capsule. Pain and functional status were assessed using the VAS, HOOS, iHOT-12 questionnaires before surgery and at 6, 12, 18, 24, 36 and 48 months postoperatively. During the surgery, correction of bone deformity of the hip joint and all identified soft-tissue damages was successfully carried out. After 5 months, the patient returned to her professional activities. According to the VAS score, pain decreased from 6 points to 0 at the follow-up time points. At the same time a periodic slight aching pain after physical activities remained. During the follow-up, the functional status was assessed as excellent according to the HOOS and iHOT-12 questionnaires. However, the patient noted slight limitations in the range of motion when performing some professional exercises.

Conclusions. The presented clinical case demonstrates that patients with hip pain whose professional activity is associated with extreme hip range of motion require special attention during clinical provocative tests and critical evaluation of effective measurements when compared with the reference values of radiologic examination methods. In the present case, arthroscopic correction of structural damages made it possible to achieve excellent functional results through the planning and performance of surgical intervention taking into account the concept of microinstability.

Background. Simultaneous bilateral femoral neck fracture is quite a rare injury. The literature describes single cases of such trauma occurrence as a result of low-energy exposure.

The aim is to demonstrate the choice of treatment tactics for a senile patient with simultaneous bilateral fracture of the femoral neck.

Case description. An 84-year-old patient suffered simultaneous fractures of both femoral necks as a result of a fall from a height of her own height. She was taken to the emergency department of the hospital, where the diagnosis was made based on a clinical and X-ray examination. Within 24 hours from the patient′s admission, after further examination in the department and due to the absence of concomitant pathology decompensation, single-episode sequential bilateral hip arthroplasty was performed using modular monopolar hemiprostheses. The patient was activated on the following day. At the time of discharge, on the 5^th day after surgery, the patient was able to move independently using additional support. The treatment result was assessed within 3 and 12 months of follow-up and was found satisfactory. A year after the surgery, the patient moves independently, goes outside with a cane without being accompanied.

Conclusions. The described non-standard clinical case should be paid a special attention when choosing the right treatment tactics. An interdisciplinary approach and the use of minimally traumatic surgical treatment techniques to ensure timely activation of a senile patient are the priorities.

Background. At present, treatment of patients with Charcot neuroarthropathy remains an unsolved problem. The current state of the problem motivated us to develop a new original method of hindfoot reconstruction aimed to form a tibiocalcaneal bone block with maximum possible preservation of limb length in patients with Charcot neuroarthropathy.

The aim of the paper was to demonstrate a new one-stage tibiocalcaneal arthrodesis technique aimed at preserving maximum possible limb length.

Surgical technique description. At the preoperative stage, the angle adjacent to the Gissan angle and its bisector is measured on X-rays. After performing the Kocher ankle approach with subsequent lateral malleolus resection and osteonecrectomy, the distal metaepiphysis of the tibia is cut in an oblique-horizontal plane at the bisector angle, open posteriorly and equal to the preoperatively measured value. The resulting triangular bone fragment is rotated by 180º and adapted within the external fixator.

Conclusion. The proposed method for total talar destruction in patients with Charcot neuroarthropathy is convenient and simple for adapting incongruent calcaneal and tibial surfaces and allows reducing the lower limb shortening in tibiocalcaneal arthrodesis.

Background. In recent years, the attention of researchers to the diagnostic method based on acoustic or vibration emission (arthrometry) has increased. The method makes it possible to detect destructive changes in the bearing components of endoprosthesis, thereby predicting their early loosening and taking appropriate preventive measures.

The aim of the review is to analyse the degree of development of vibration arthrometry methods and its role in identifying early (pre-radiological) signs of loosening of endoprosthesis components and destructive changes in them (adverse events) after hip arthroplasty.

Methods. The information was searched in eLIBRARY, PubMed, Google Scholar, and Crossref electronic databases in Russian and English. The search was performed using the following keywords: acoustic emission, vibration arthrography, vibration arthrometry, hip joint, arthroplasty. The depth of the search: from 1990 to March 2024.

Results. A total of 34 literature sources were selected. None of the studied technologies was included in the number of generally accepted medical studies, since all have significant limitations, such as dependence on the density of soft tissues surrounding the endoprosthesis, the unresolved issue of the sensors location. Also, most of the technologies have not been tested in vivo, which would show their real potential for subsequent integration into the medical system. Nevertheless, most experimental studies have demonstrated a positive result in the diagnosis of loosening, destruction of the cement mantle and endoprosthesis components.

Conclusions. The advantage of vibration arthrometry as an independent diagnostic method is that it confirms loosening of endoprosthesis components, destruction of the cement mantle and ceramics at early stages before radiographic manifestations of ongoing processes.