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The aim of the study was to test an innovative implant made of the urethane bone-replacing material Rekost-M using 3D technologies for customized reconstruction of post-craniotomy skull defects. Materials and Methods. To study the properties of the bone replacement material Rekost-M, physical, mechanical and toxicological tests, as well as preclinical studies on fibroblasts cultures and lab animals (rabbits) were carried out. Clinical evaluation of the developed implant was conducted within a multicenter trial. Results. The replacement of post-craniotomy skull defects with implants made of the bone replacement material Rekost-M represents a reliable method of cranioplasty. Using 3D technology allows for modeling of individual implants of any complexity.

Relevance. The altered hip anatomy makes total hip arthroplasty in patients with hip dysplasia a difficult and non-standard task. The acetabulum is deformed with femoral head in subluxation or dislocation. The most important task of surgery is to restore the anatomical position of the hip center of rotation.The study purpose — to evaluate the early results of hip arthroplasty with individual augments in the patients with hip dysplasia.Materials and Methods. Since 2017, nine patients with hip dysplasia have undergone surgery using individually printed augments. All patients were women with average age 51.3±14.5 years (23 to 67). The mean follow-up was 14.3±5.2 months (8 to 20). Patients were evaluated using follow-up X-rays, a visual analogue scale (VAS), Harris Hip Score (HHS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC).Results. There was no a single case of endoprosthesis dislocation, loosening of components, prosthetic infection or revision surgery in the analyzed group of patients. The planned sizes of the acetabular components were equal to the placed in 7 cases (77.8%). In two cases (22.2%), the acetabular components were 2 mm larger because the surgeon wanted a greater degree of press-fit fixation. The restoration of the anatomical position of the acetabular component was noted. Before the surgery, the femoral head was on average 22.7±11.7 mm (10 to 43 mm) higher. After the surgery, the level of the acetabular component was on average only 0.75±2.1 mm (1.7 to 5 mm), p = 0.008. Also, there were a decrease in pain and quality of life improvement by VAS from 6.78±1.39 before surgery to 2.22±1.09 at follow-up (p = 0.007), HHS increase from 30.5±18. 1 to 77.59±14.26 (p = 0.008), and WOMAC decrease from 73.3±14.1 to 18.22±8.2 (p = 0.008).Conclusion. The individually printed augments have shown high efficacy for restoration of the anatomical center of rotation and good early results in the patients with hip dysplasia undergone hip arthroplasty.

The objective of the study was to evaluate the effectiveness and safety of high-volume local infiltration and epidural analgesic techniques after primary total knee arthroplasty versus standard systemic multimodal analgesia in the context of the postoperative analgesia protocols.Materials and Methods. A single-center randomized comparative study included 84 patients who, from august 2017 to august 2018, underwent a primary total knee arthroplasty. Depending on the method of postoperative analgesia, we randomized patients into 3 groups. Group A consisted of 32 patients who received intraoperative infiltration of periarticular tissues with 0.2% solution of ropivacaine in combination with adrenaline and subsequent bolus injection of a local anesthetic solution via a catheter inserted into the wound. Group B included patients who received epidural analgesia with a constant infusion of a 0.2% solution of ropivacaine (n = 28). In patients of group C, neither regional nor local analgesia techniques were used for postoperative analgesia (n = 24). All patients received standard systemic multimodal analgesia using nonsteroidal anti-inflammatory drugs and tramadol. The pain intensity was measured by vas when the patient was motionless, and during knee flexion (before surgery, after surgery on resolution of motor block and during the initial postoperative 24 h), side-effects were recorded.Results. The patients of Group C, during knee flexion in the postoperative period, reported the highest pain scores (6 (5; 8) during the initial postoperative 12 h and 6 (5; 6) during the initial postoperative 24 h). Severe pain, resistant to therapy and requiring the administration of narcotic analgesics (morphine 1.0 mg), was noted in 5 (15.6%) patients in group A and in 10 (41.6%) in group C, in contrast to patients of group B, where no pain was recorded in any patient, p = 0.056, p = 0.037 and p<0.0001. Hypotension was observed only in group B in 6 (22%) patients. Intra-articular and other infectious complications among all patients were not recorded.Conclusion. High-volume local infiltration analgesia as a modality of postoperative analgesia is not inferior in the effectiveness to the epidural analgesia, does not require strict monitoring and is accompanied by a lower incidence of side-effects and complications, which can make it the procedure of choice in multimodal analgesia schemes for total knee arthroplasty.

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BACKGROUND: The use of local high-volume infiltration anesthesia (LHVIA) is becoming increasingly popular for postoperative analgesia in total knee arthroplasty (TKA). However, one of the elements of the technique is the use of an intraarticular or wound catheter to prolong the analgesic effect. AIM: Therefore, the investigation aimed to estimate wound catheter use as a component of LHVIA in TKA. MATERIALS AND METHODS: The study included 102 patients who underwent primary TKA for stage 3 gonarthrosis under spinal anesthesia with intravenous sedation. Two groups were formed by envelope randomization: the LHVIAc group (n=51) in which the wound catheter was placed at the end of the operation and followed by the infusion of the local anesthetic solution for 24 h; and the LHVIA group (n=51) in which the patients were treated without a catheter. RESULTS: The groups were comparable in terms of sex, age, and the nature of the pathology. The LHVIAc group showed a significantly decreased severity of pain in 46 h after surgery, both at rest and during flexion of the knee (p=0.001 and p=0.003). On postoperative day 1, the use of the wound catheter contributed to a significantly decreased severity of pain syndrome when flexing the knee (p=0.002). No infectious complications or significant adverse reactions were recorded in the groups. CONCLUSION: 1) LHVIA is an effective method of postoperative analgesia in TKA; 2) the use of the catheter in the early postoperative period increased the analgesic effect of LHVIA without increasing the frequency of infectious and other complications; 3) the use of the wound catheter reduced the severity of pain syndrome in postoperative day 1 during activation, which facilitates postoperative rehabilitation of patients with TKA.