Treatment of avascular necrosis of the femoral head is an issue of current interest while it affects young and employable people. So far there is no well-defined strategy of management which would help to postpone hip arthroplasty and further revision procedure. Hip sparing surgical treatment of avascular necrosis of the femoral head by bone grafting prior to head collapse proved to be a viable option not only during early stages of disease but also at advanced stages. platelet-rich plasma (pRp) addition to treatment plan potentially helps improving bone regeneration in situ. In this article the authors present a case of a 37 years old patient with avascular necrosis of the femoral head at a fragmentation stage (type 4B by aRcO). The authors centrifuged 15 ml of autologous whole blood (1500 RpM) obtained by a special double-contoured syringe. during the surgical stage of treatment pRp and morselized bone graft were mixed to introduce and impact into the debrided zone of avascular necrosis. The authors also introduced 0.3-0.4 ml of pRp into the debrided zone of avascular necrosis after bone grafting. at 6 months follow-up cT images of the studied patient demonstrated signs of bone reorganization and no loss of femoral head sphericity. preoperative Visual analogue Scale (VaS), Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Score (HOOS) prior to treatment were 60, 45 and 33 points respectively. postoperative VaS, HHS and HOOS scores were 10, 78 and 78 respectively. In the authors' opinion, impaction bone grafting enhanced by pRp helps obtaining good and excellent outcomes not only at early but also at advanced stages of avascular necrosis.
Background.Hip arthroscopy is a minimally invasive surgical technique most commonly performed to correct femoroacetabular impingement (FAI). The number of hip arthroscopy performed in Russia is unknown. Information about this surgical technique is also very limited in our country.The aim of the study was to assess the level of hip arthroscopy in Russia.Methods.A sociological survey of orthopaedic surgeon with experience in performing hip arthroscopy was conducted. The questionnaire was posted on the Google Forms platform. The survey included 54 surgeons from Russian clinics, 45 people filled out the questionnaire.Results.The majority of specialists (73,30,06%) were trained in hip arthroscopy. More than half of the respondents (68,80,06%) are currently engaged in this surgical area, however, in 45,160,07% of them, the number of operations does not exceed 5 per year. For surgeons who have completed two or more training courses, the volume of operations performed is higher (p0,05). 51,110,07% of doctors perform arthroscopy using an alternative technique. There are 2,5 time more specialists doing just bone resection, than surgeons who apply any kind of reconstruction technique while treating FAI (p0,05). Fifteen respondents (48,390,08%) perform debridement as an attempt to delay arthroplasty. The most common difficulties faced by surgeon are problems with the diagnosis of FAI (400,02%), lack of the necessary tools (400,02%) and sufficient time to master the technique (33,30,07%). Only three (6,60,07%) respondents believed to achieve planned results, 93,30,03% of surgeons said that it is not always possible to achieve the desired outcomes.Conclusion. Hip arthroscopy in Russia is not very common, the volume of such interventions is insignificant. Doctors not skilled in arthroscopic hip surgery predominate. Factors impeding the development of this area in our country are related to teaching methods, FAI diagnostics, the lack of necessary instruments for performing operations, and the lack of time for specialists to master surgical techniques.
acetabular defects are a major obstacle to achieving good outcomes after revision hip arthroplasty. one way to deal with this problem is to use acetabular augments. We aimed to describe mid-term outcomes of revision hip arthroplasty using acetabular augments. Materials and methods. We analyzed 85 cases (83 patients) of revision hip arthroplasty using acetabular augments performed during 2012-2018 period: 53 women and 30 men with average age of 57±13 years (25-79). Distribution of acetabular defects was: 51 cases-Paprosky IIIa, 17 cases-Paprosky IIIB, 12 cases-Paprosky IIB, 5 cases-Paprosky IIc. 14 patients had chronic pelvic discontinuity. aseptic loosening was indication for the operation in 83 cases, periprosthetic hip fracture-1, dislocation-1. The amount of previously undregone ipsilateral hipsurgeries was 1 in 35 cases, 2 in 25 cases, 3 and more in 25 cases. average follow-up period was 38±19 months (1-79). Results. The average HHS score improved from 37±7 preoperatively to 73±9 after 3 months and to 80±11 after 12 months postoperatively (p = 0.001). average VaS score improved from 7±2 preoperatively to 4±1 after 3 months and to 3±1 after 12 months postoperatively (p = 0.001). Stable acetabular fixation was achieved in each case according to x-ray findings at final follow-up. However, radiolucent lines were present around the cup in 10 cases (11.8 %) followed by no clinical evidence of aseptic loosening. Hip center of rotation was restored from 26.40±18.38 mm (4-75) preoperatively to 4.78±5.02 mm (0-20) postoperatively relatively to 0 point. complications manifested in 9 out of 85 cases (10,6%). Distribution of complications was: periprosthetic joint infection in 6 cases, recurrent dislocation-2, periprosthetic hip fracture-1.7 patients required implant removal and exchange. Conclusions. Good mid-term outcomes can be achieved using acetabular augments during hip revision surgery in setting of acetabular defects. acetabular augments are a reliable option in case of Paprosky IIIB, IIIa defects and chronic pelvic discontinuity, providing good mechanical stability.
The analysis of total knee arthroplasty results was performed in 106 patients operated on for III stage of deforming gonarthrosis. All patients were divided into 2 groups depending on the presence of the angular extremity axis deformity. Clinical and functional assessment was performed using visual analog scale, Joseph & Kaufman scale, SF-36 questionnaire. Treatment results were evaluated in 3, 6 months and 1, 3, 5 years after intervention. In the group of patients with axial leg deformity the duration of surgical intervention, intraoperative blood loss and postoperative hospitalization period were higher than in patients with normal leg axis but the differences were not significant. The height of the implant insert was 12 (8-14) mm with normal axis and 14 (14-15) mm with axial deformity ( p =0.000187). Correction of the leg axis during arthroplasty required larger bone cuts and soft tissue release but the parameters characterizing leg axis normalization did not differ statistically significant between the groups. However in 5 years after intervention the patients with normal lower extremity axis showed reliably better results by all scales and questionnaires.
Федеральное государственное бюджетное учреждение «Приволжский федеральный медицинский исследовательский центр» Минздрава России, Нижний Новгород, Российская Федерация Цель. Разработать трехмерную комбинированную клеточно-инженерную конструкцию (КИК) для вос-становления ограниченных повреждений суставного хряща в эксперименте. Материалы и методы. Для создания клеточно-инженерной конструкции (КИК) использованы коллагеновые носители: двухслойная непроницаемая мембрана «Chondro Gide» и проницаемая матрица «Остеопласт», проводилось сравни-тельное исследование их цитотоксических, адгезивных свойств in vitro. Хондропластический потенциал подготовленных КИК на основе коллагеновых матриц с выращенными на их поверхности аллогенными мезенхимальными стволовыми клетки (МСК) костного мозга кролика оценивался in vivo. Кроликам на обеих лапах был сформирован цилиндрический дефект суставного хряща внутреннего мыщелка бедрен-ной кости диаметром 3,3 мм на глубину 1,5 мм. При этом лабораторные животные были разделены на 3 группы: контрольная; группа «Опыт 1», в которой в качестве носителя для МСК в составе КИК исполь-зовался «Chondro Gide»; группа «Опыт 2», где была применена матрица «Остеопласт». По завершении эксперимента проводились морфометрическое и гистоморфологическое исследование образцов тканей. Для статистической оценки результатов был предложен и использован коэффициент восстановления об-ласти дефекта (КВ). Результаты. Через 6 месяцев наблюдений в контрольной группе отмечено частич-ное восстановление области дефекта, коэффициент восстановления (КВ) составил 0,62 ± 0,06. В группе «Опыт 1» КВ был равным 0,79 ± 0,07, в группе «Опыт 2» КВ находился на уровне 0,88 ± 0,02. Ста-тистическая оценка результатов исследования показывает, что применение КИК, используемой в группе «Опыт 2», позволяет снизить относительный риск наступления неблагоприятных исходов лечения на 92,9%, абсолютный риск -на 43,3% по сравнению с группой «Опыт 1». Данные гистоморфологичес-кого исследования свидетельствуют о формировании в центральной зоне дефекта гиалинового хряща, местами максимально приближенного к интактному хрящу с обозначением зональности. Заключение. Результаты исследования разработанной трехмерной клеточно-инженерной конструкции, состоящей из мезенхимальных стволовых клеток костного мозга, выращенных на проницаемой коллагеновой матрице «Остеопласт», демонстрируют формирование в области ее имплантации хрящевой гиалиновой ткани с высокой степенью структурной организации. Вновь образованный хрящ лишь незначительно уступает по толщине предсуществующей хрящевой ткани, что способствует динамическому распределению осе-вой нагрузки по суставной поверхности и в совокупности позволяет надеяться на хорошие долгосроч-ные результаты. Таким образом, на основании полученных данных считаем обоснованным проведение следующих этапов исследования предложенной клеточно-инженерной конструкции для хондропластики ограниченных дефектов суставного хряща. Ключевые слова: суставной хрящ, хондропластика, клеточно-инженерная конструкция (КИК), мезенхимальные стволовы...
The analysis of total knee arthroplasty results was performed in 106 patients operated on for III stage of deforming gonarthrosis. All patients were divided into 2 groups depending on the presence of the angular extremity axis deformity. Clinical and functional assessment was performed using visual analog scale, Joseph & Kaufman scale, SF-36 questionnaire. Treatment results were evaluated in 3, 6 months and 1, 3, 5 years after intervention. In the group of patients with axial leg deformity the duration of surgical intervention, intraoperative blood loss and postoperative hospitalization period were higher than in patients with normal leg axis but the differences were not significant. The height of the implant insert was 12 (8-14) mm with normal axis and 14 (14-15) mm with axial deformity ( p =0.000187). Correction of the leg axis during arthroplasty required larger bone cuts and soft tissue release but the parameters characterizing leg axis normalization did not differ statistically significant between the groups. However in 5 years after intervention the patients with normal lower extremity axis showed reliably better results by all scales and questionnaires.
BACKGROUND: Tibial plateau fractures (TPF) are common and account for up to 1% of all fractures. The most unfavorable results of their treatment occur with nonunion, malunion, and malunion of TPF fractures. Unfavorable functional results of treatment are due to the occurrence of stiffness in the joint, the development of post-traumatic osteoarthritis, instability in the joint and the presence of infectious complications. In this case, there are indications for surgical treatment of intraarticular fractures of TPF. AIM: to evaluate long-term results and factors leading to knee arthroplasty after reconstructive surgery for post-traumatic deformities of the proximal tibial epimetaphysis. MATERIALS AND METHODS: The long-term (in terms of 5 to 10 years) treatment results were assessed in 46 patients with malunion of intra-articular fractures of the tibial plateau, operated in the period from 2010 to 2015.The average age of patients was 47.611 years. We considered both cases of neglected conservative treatment (87%) and cases with unsuccessful surgical fixation (13%). RESULTS: The KOOS pain score was 75.0 [66.6; 94.0] points, which corresponds to a good result. Satisfactory results were observed during the examination on the basis of daily physical activity (66.1 [51.5; 85.3] points) and on the basis of symptoms and stiffness (65.4 [53.6; 86.0] points). Average scores for the attribute physical activity while playing sports, games and entertainment and for the attribute quality of life 53.75 [25.0; 81.0] and 53.8 [25.0; 81.0] points, respectively, were assessed as unsatisfactory. In terms of up to 10 years, 5 out of 46 patients (10.9%) underwent knee arthroplasty. A statistically significant relationship was determined between the varus deformity more than 3 persisting after reconstructive surgery (r=0.664, p 0.0001), the time period between injury and reconstructive surgery (r=0.262, p=0.007) and the appearance of indications for TKA. CONCLUSION: The study revealed a statistically significant direct correlation relationships between persisting varus deformity more than 3, as well as a long time interval between injury and the performed reconstructive surgery with the emergence of indications for arthroplasty.
The aim of the study was to evaluate the long-term results of surgical treatment of patients with extensive bone defects (2B и 3 according to AORI) of the proximal tibia and/or distal femur using custom-made implants for revision knee arthroplasty. Material and methods. A retrospective clinical study was conducted in 24 patients who underwent revision arthroplasty using individual implants (9 femoral and 18 tibial) made on a 3D printer in the period from 2017 to 2021. T3 defect according to AORI classification was diagnosed in 12 patients (50%), F3 defect - in 1 (4.17%), F2B - in 8 (33.3%), T2B - in 6 (25%). All patients before surgery and 3, 6, 12 months after surgery were subjected to a questionnaire survey using the international scales VAS, KSS, WOMAC and SF-36. Results. At the follow-up examination 12 months after the operation, 9 out of 24 patients (37.510%) moved without additional means of support, 10 out of 24 (41.710%) with a cane, 4 out of 24 (16, 78%), walkers 1 out of 24 (4.210%). There were no periprosthetic fractures during surgery and in the postoperative period. Conclusion. The use of individual implants made using additive 3D printing technologies in revision knee arthroplasty in the presence of extensive bone defects (2B and 3 according to AORI) allows performing an organ-preserving operation without loss of the statodynamic function of the lower limb.
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