Experience with external fixation devices during preoperative preparation and planning of primary and revision hip arthroplasty in complicated cases of rigid hip deformity

Цель исследования-сравнить результаты подвертельной укорачивающей остеотомии и проксимальной остеотомии по Paavilainen при тотальном эндопротезировании тазобедренного сустава пациентам с дисплазией III и IV степеней по Crowe. Материал и методы. Было выполнено 36 операций эндопротезирования тазобедренного сустава 33 пациентам с дисплазией III (12) и IV (24) степеней по Crowe с использованием двух методик укорачивающей остеотомии:

Section: Discussionunclassified

Comparative Assessment of Subtrochanteric Shortening Osteotomy and Paavilainen’s Proximal Osteotomy in Total Hip Arthroplasty for Crowe III–IV Dysplasia

Корыткин

Герасимов²,

Novikova³

et al. 2020

“…предположительно неудовлетворительные результаты лечения пациентов с переломами типа B1 могут быть связаны с нарушением техники выполнения фиксации или недооценкой стабильности бедренного компонента при дифференциальной диагностике переломов типа B1 и B2 [19,21]. Использование предоперационных рентгенограмм может быть недостаточно надежным для оценки стабильности бедренного компонента имплантата, поэтому важно проводить дополнительную проверку стабильности ножки эндопротеза интраоперационно [21,22,26]. В.В.…”

Section: таблица 4 структура осложнений после первичного лечения периunclassified

Outcome of Periprosthetic Femoral Fractures in Hip Arthroplasty

Корыткин

moudni

Мудни³

et al. 2018

Periprosthetic fractures are one of the main reasons for revision surgery according to the data of large joint replacement registers. Treatment of patients with periprosthetic fractures is associated with a big number of complications and still keeps its relevance. Purposeof the study is to evaluate treatment outcome of patients with periprosthetic femoral fractures in hipreplacement. Material and Methods.The authors performed a retrospective analysis of medical histories of 76 patients whounderwent treatment of periprosthetic femoral fractures. The patients were divided into groups by the Unified Classification System (UCS). Follow up period was from 6 to 124 months (mean of 34.90±28.81). Results.3 cases (3.9%) of periprosthetic femoral fractures were the complications after primary hip arthroplastyand occurred intraoperatively, 75 cases (96.1%) were complications after revision surgery; 56 cases (71.8%) were reported with uncemented and 22 cases (28.2%) with cemented femoral components. In 30 cases (38.5%) fractures had a iatrogenic nature and occurred intraoperatively, in 48 cases (61.5%) — occurred due to high- and low energy trauma. Type B fractures were observed most often — in 53 cases (68%). Conservative treatment, fixation by cerclage or by plate and screws has proven to be the least effective operative options. In the group of patients with extended osteotomy of the greater trochanter the healing was achieved in 90.5% of cases, while in the group without osteotomy — in 75% of cases. Low healing rate of periprosthetic fractures was observed for A and B1 type fractures (65% and 66.7% respectively). Follow up of patients with B2, B3 and C type fractures demonstrated consolidation in more than 80% of cases. Various complications were reported in 17 cases (21.8%). Conclusion.Effective treatment of patients with periprosthetic femoral fractures was associated with extendedosteotomy of the greater trochanter (γ = 0.51;p= 0.032), absence of complications in postoperative period (R= 0.55;p= 0.00001), B2, B3 and C fracture types (γ= 0.40;p= 0.02) and use of revision uncemented femoral components withdistal fixation (γ = 0.35;p= 0.018). In the authors opinion use of sutures or cerclage wires are not effective in cases of trochanteric fractures and stable femoral components; it would be preferable to perform internal fixation by a plate with hooks such as Dall-Miles. In case of doubts in regard of stem stability the revision should rather stipulate use of uncemented femoral components, in particular long stems with distal fixation.

Effects of 3D Imaging on Surgical Tactics in Primary and Revision Hip Arthroplasty

Базлов

Мамуладзе

Голенков

et al. 2020

3D imaging tools significantly expand the ability to assess the bone tissue condition, both in terms of its qualitative properties and in terms of accurate determination of bone defect geometry and volume.The purpose of the study was to determine the 3D imaging potential for the preoperative planning and correction of surgical tactics in hip arthroplasty.Materials and Methods. A retrospective analysis of the preoperative planning of 110 primary and revision hip arthroplasties with 3D imaging was performed. The following specialized software were employed: RadiAnt DICOM Viewer file converter — for 3D models production; 3D/CAD designers — for volumetric models processing and correction; InVesalius 3.0 program — for bone density evaluation by the Hounsfield scale; K-Pacs — for viewing MSCT and X-ray images. All patients underwent pelvic bones radiography in the front and anterior-lateral planes. Post-traumatic acetabular deformity was described in accordance with the X-ray picture in each individual clinical case. For revision arthroplasty, the acetabular defect was determined according to the W.G. Paprosky classification. In 36 patients (32.7%), the acetabulum defect was the result of trauma. In 74 patients (67.3%), the cause of surgery was endoprosthesis components loosening.Results. In 80% of cases (88 patients), the analysis of the 3D model did not change the surgical tactics determined in the preoperative planning using pelvic radiographs; in 20% of cases (22 patients), the use of 3D imaging revealed new circumstances and changed the surgical tactics.Conclusion. In standard cases, it is possible to use the traditional preoperative planning using radiographs in several planes. In primary hip arthroplasty in the patients with post-traumatic deformity, including a false joint of acetabulum bottom or 2 to 3 degree osteopenia, it is advisable to perform 3D imaging. In the case of revision arthroplasty, 3D visualization is indicated in acetabulum Paprosky IIIA, IIIB defects with pelvic discontinuity.