Experience in hip and knee arthroplasty (primary and revision) accumulated at CITO department for large joints arthroplasty during the period from 1990 to 2010 is presented. Dynamic of the development of that direction in traumatology and orthopaedics, i.e. perfection of implants and surgical technique, is shown. Typical difficulties and complications in primary and revision operations are noted. Elaborated at the department technique for acetabulum reconstruction at revision hip arthroplasty in patients with significant deficit of bone mass and disturbance of mechanical bone strength is described.
Clinical observation of patient undergone two revisions total knee arthroplasty was presented. The cause of revisions was clinical manifestation of inflammatory but no classic signs of infection were detected intraoperatively. Cupping of inflammatory was succeeded after insertion of implant coating by nitride ceramics. Possible inflammatory development as allergic reaction to cobalt was discussed.
Experience of CITO joint replacement department in knee arthroplasty with implants from various manufacturers was analyzed. Implants of three modifications were used: basic, with posterior stabilizer and "semiconstrained" one. Tactics for a choice of optimum construction depending on a disease, gender, degree and type of contracture, degree and type of limb axis curvature was demonstrated and substantiated on the example of 500 operations performed to 426 patients with various knee joint pathology during the period from 2000 to 2010. By the data of clinical and roentgenologic analysis excellent result was achieved in 90 (21%), good inv 277 (65%), satisfactory in 51 (12%) and poor in 8 (2%) patients. This treatment tactics may be considered as an adequate one.
Clinical and roentgenologic as well as pathomorphologic peculiarities of III-IV stage of coxarthrosis were studied in 254 patients who underwent surgery at the CITO department of joint replacement. Coxarthrosis with cystic alteration of the articular bone structure has been diagnosed in 56% of patients. Cystic alteration was more often detected in middle (II), the most common degree of articular dysplasia. In the absence of dysplasia or in its marginal degrees the noncystic type of coxarthrosis prevailed. It was shown that in patients with cystic coxarthrosis the progress of pathologic process was faster and such patients more often had concomitant diseases characterized by microcirculatory disturbance. Pathomorphologic examination also showed more marked changes of microcirculatory channel in cystic coxarthrosis bone structure. In 47 patients the comparison of roentgenologic indices of the quality of secondary implant fixation and peculiarities of coxarthrosis ( either with or without cystic alteration) performed 3 to 4 years after uncemented total hip replacement by ESI implant demonstrated reliably better quality and longer fixation of bone tissue to the structured surface of the implant in noncystic type of coxarthrosis.
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