Background. In case if it is impossible to eliminate the knee contracture by soft tissue release, external fixation is additionally used. Most often, the Ilizarov apparatus with a uniaxial hinge is used for this purpose. Orthopedic hexapods, unlike the Ilizarov frame, are able to reproduce the kinematics of movements in the knee joint. Aim of the study to evaluate the effectiveness of orthopedic hexapod for the treatment of patients with knee extension contractures in comparison with the Ilizarov apparatus. Methods. We analyzed 64 cases of combined treatment of extension knee contractures, which were divided into two groups. In the 1st group (31 patients) in addition to the soft tissue release, the orthopedic hexapod Ortho-SUV Frame (OSF) was used. In the 2nd group (33 patients) the Ilizarov apparatus with an uniaxial hinge was used. In a comparative analysis between groups, the number of flexion-extension cycles, the time required to complete them, and the time needed for complete knee range of motion (ROM) restoration were evaluated. Functional results were assessed using specialized scales-questionnaires KSS, Lysholm, LEFS in 2 days, 6 and 12 mon. after frame dismantling. Results. Comparing the total external fixation period, as well as the time needed for ROM restoration, no significant difference between groups was found (р0.05). When using the orthopedic hexapod, in comparison with the Ilizarov apparatus, fewer flexion-extension cycles were required. When assessing the amplitude of movements in 12 mon. in the first group, excellent results were found in 27 patients and good results in 4. In the second group, in all 33 patients good ROM was evaluated. On average, the ROM in the 1st group was 20 more than in the 2nd group. The knee function in 12 mon. was 16 points higher on the KSS in the 1st group, 5 points higher on the Lysholm scale, and 15 points higher on the LEFS scale than in the 2nd group. When analyzing the frequency of complications, no significant differences were found (р0.05). Conclusions. The results obtained indicate the effectiveness of the orthopedic hexapod in the treatment of patients with knee extension contractures.
Известные до настоящего времени компоновки ортопедического гексапода, применяемые при лечении контрактур коленного сустава, были разработаны на костных муляжах бедренной и большеберцовой костей без учета мягких тканей. Вследствие этого не мог быть учтен возможный «конфликт» страт с мягкими тканями: их соприкосновение, препятствующее дальнейшему сгибанию голени. Настоящее исследование позволило решить эту проблему. В ходе эксперимента были проведены замеры длины и окружности бедра у пациентов с эндоморфным и мезоморфным типом телосложения. По результатам замеров были изготовлены модели нижних конечностей, включающие мягкие ткани бедра и голени. Для каждого соматотипа были подобраны кольцевые опоры в соответствии с окружностью бедра и голени. Обеспечиваемая компоновкой амплитуда движений в коленном суставе была исследована при расположении базовой и мобильной опор гексапода на расстояниях 100, 120, 140, 160 мм от суставной щели. В результате выяснено, что независимо от соматотипа наибольшая амплитуда движений в коленном суставе обеспечивается установкой базовой и мобильной опор на расстоянии 160 мм от суставной щели коленного сустава. Наклон базовой опоры должен составлять 60°, мобильной -120º. Страты №№ 1, 2 и 6 должны быть фиксированы к опорам при помощи Z-образных платиков. Ключевые слова: аппарат внешней фиксации, ортопедический гексапод, коленный сустав, контрактура.
Relevance. Knee contractures have an impact on quality of life and are also a common cause of disability. The use of external fixation devices has a certain place in the treatment of this pathology.Purpose. Using the world literature, to identify the modern position, problems, and prospectives of external fixation in the treatment of knee flexion and extension contractures in adult patients.Methods. EMBASE, Medline, Google Scholar, PubMed, e-LIBRARY, and Cyber resources were used. The analysis included publications relative treatment of knee joint stiffness using external fixation in patients over 18 years old, regardless of gender. At analysis several criterial were used: frame ability to provide movements in the knee joint according with its natural kinematics (biomechanics), stable fixation of the femur and tibia, and possibility inserting wires and halfpins in projection of Reference Positions (RP).Results. The devices used in the treatment of knee joint contractures in adult patients were conditionally divided, depending on the type of hinge, into 4 groups: non-hinged, uniaxial, reproducing, and virtual. It has been established that only orthopedic hexapods, based on virtual hinge, can meet all of the criteria mentioned above. However the technology of any orthopedic hexapod hardware and software usage for the treatment of contractures of the knee joint, was not developed till now.Conclusion. The necessity of developing hex-based technology for treatment patients with knee joint contractures was justified by world literature review. Hexapod hardware must provide possibilities of any inclination angle of any ring, and struts fixation not only to base and mobile rings, but to stabilizing as well. Software should be equipped with multi-total residual option. Ortho-SUV Frame (OSF) meets these requirements.
Background Extraarticular deformity of the femur or tibia may be critical for the success of primary total knee arthroplasty (TKA). Recognizing an extraarticular deformity preoperatively allows a surgeon to choose between various management strategies. The surgical treatment options for correction of an extraarticular deformity include (1) primary TKA, (2) simultaneous corrective osteotomy and TKA and (3) staged corrective osteotomy and delayed TKA. Objective To substantiate differentiated approach to treatment strategies for osteoarthritic knee with extraarticular deformity based on international and our own experience. Material and methods Comparative analysis of current literature on surgical treatment of extraarticular deformities in arthritic knees was produced. The differentiated approach was illustrated by a clinical instance of a 35-year-old patient with bilateral end-stage gonarthrosis associated with extraarticular deformity of both lower limbs. Staged treatment was considered for the congenital multiplanar multilevel deformity in the shaft of the left femur with 26º valgus alignment, procurvatum, external rotation to be corrected with bifocal osteotomy addressing all components of the deformity and stabilized with interlocking intramedullary nail. Standard TKA on the left side was produced a year later with posterior cruciate ligament (PCL) retention. Acquired uniplanar varus deformity of the right femur was corrected using computerassisted navigation TKA and the PCL substitution at 5 months after the first procedure. Results Knee score improved from 28 to 85 and from 52 to 86 in the left and right sides while functional activity score increased from 42 to 90 and from 52 to 92, respectively, as measured with American Knee Society scoring system (KSS). There is plenty of evidence in the literature that computer-assisted navigation TKA facilitates accurate limb alignment, better flexion angle and improved functional score whereas osteotomies are associated with a higher risk of complications that can result in delayed consolidation or nonunion. Conclusion Differentiated approach can be advocated for correction of an extraarticular deformity of lower limb to be addressed with TKA depending on the magnitude (in degrees), the location of the deformity in relation to the knee joint and relevant patient specific charactreristics, such as age, gender, clinical history. Computer-assisted navigation TKA is practical for mild diaphyseal deformity associated with gonarthritis. Corrective osteotomy can be useful for severe diaphyseal deformity or with the apex localized close to the joint for realignment at the first stage.
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