Morphofunctional remodeling of bone tissue during periprotheric fractures in the femoral component

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Abstract


Periprosthetic fractures in the area of the femoral component after hip replacement are one of the reasons for performing revision surgery. The treatment is always associated with many complications and therefore does not lose its relevance. The aim of our research was a pathomorphological study of bone tissue repair and reactive changes in the soft tissues around the periprosthetic fracture after arthroplasty. The research results will predict the long-term outcome and stability of the revision endoprosthesis.

Materials and methods. The materials for pathomorphological studies were biopsy, (11 — periprosthetic fractures in the zone of the femoral component, 5 — from the hip joint), fragments of bone tissue from the zone of the periprosthetic fracture, femoral canal, altered connective tissue obtained by repeated interventions in the area of periprosthetic fracture, and revision endoprosthetics. Pathomorphological studies of biopsy specimens of bone fragments and soft tissues were carried out after conventional histological processing with the production of histological sections, 5–7 μm thick, followed by staining with hematoxylin and eosin and according to Van Gieson.

Results. Morphological signs of structural disorganization of bone tissue in the fracture zone were revealed after fragments of bone and soft tissues were removed from the fracture zone; various options for repair of bone tissue were investigated, as well as reactive changes up to ischemia from the surrounding soft tissues were observed. Signs of damage to the tubules, lacunae and trabeculae, and with them the intraosseous branches of the supplying artery were noticed. Bone tissue repair in the area of periprosthetic fractures was carried out in various ways: due to activation of osteoblasts, through endesmal osteogenesis (from preexisting fibrous structures), endochondral osteogenesis (from provisional corns), as well as mixed osteogenesis from complexes of bone–cartilaginous tissue. Slowing of osteogenesis was the reason for the formation of appositional gluing lines in bone trabeculae, which are considered as a morphological sign of delayed osteogenesis. The absence of multinucleated osteoclasts in the bone tissues we studied is apparently due to the fact that pathological osteolysis with signs of ischemia does not develop in the fracture zone.

Conclusion. The results of our histopathological studies indicate that by the time of revision endoprosthetics in the area of femoral fractures, morphological signs of a slowdown in reparative osteogenesis develop with the pathological functional remodeling of bone tissue and microischemia in the bone and, of course, in the surrounding soft tissues.


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About the authors

Nurlan D. Batpenov

Scientific Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: niitokz@mail.ru
ORCID iD: 0000-0001-5607-3397

Kazakhstan, Nur-Sultan

Doctor of Medical Science, Professor, Corresponding member of Academy of Medicine Science, Director

Serik K. Rakhimov

Scientific Research Institute of Traumatology and Orthopedics; Non-commercial joint-stock company “Astana medical university”,
Nur-Sultan

Email: rakhimovsk@mail.ru

Kazakhstan, Nur-Sultan

Doctor of Medical Science, Professor, Chief Scientific Researcher; Curator of Polytrauma Department, Professor of the Department of traumatology and orthopedics

Alexei A. Stepanov

Scientific Research Institute of Traumatology and Orthopedics

Email: jsars@mail.ru

Kazakhstan, Nur-Sultan

Head of the Department of traumatology No. 2

Didar A. Orasbaev

Scientific Research Institute of Traumatology and Orthopedics

Email: zh.aitykova@mail.ru

Kazakhstan, Nur-Sultan

resident of the traumatology department No. 2 (polytrauma)

Kenzhegul B. Manekenova

Non-commercial joint-stock company “Astana medical university”,
Nur-Sultan

Email: rakhimovsk@mail.ru

Kazakhstan, Nur-Sultan

Doctor of Medical Science, Professor, Head of the Department of Pathologic Anatomy

Gulzira K. Smailova

Non-commercial joint-stock company “Astana medical university”

Email: rakhimovsk@mail.ru

Kazakhstan, Nur-Sultan

Candidate of Medical Science, Assistant of the Department of Pathologic Anatomy

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Supplementary files

Supplementary Files Action
1.
Fig. 1. Destructive changes in periprosthetic fractures bone tissue of the femoral component: a — destroyed bone beams with focal accumulations of small bone fragments; b — axillary osteolysis in cartilage ossification fabrics. Staining with hematoxylin and eosin. Magnification × 160

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2.
Fig. 2. Reparative changes in periprosthetic fractures bone tissue of the femoral component. The zone of formation of immature bone tissue with a predominance of loosely fibrous interstitial tissue containing many neglected thin-walled vessels. Staining with hematoxylin and eosin. Magnification × 100

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3.
Fig. 3. Reparative changes in periprosthetic fractures bone tissue of the femoral component: between the mature bone trabeculae — a section of chondroid metaplasia of bone tissue basic substance of fibrous structure. Staining according to Van Gieson. Magnification × 160

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4.
Fig. 4. Reparative changes in periprosthetic fractures bone tissue of the femoral component: proliferation of fibrous tissue around the fragments of the bone beams. Staining with hematoxylin and eosin. Magnification × 160

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5.
Fig. 5. Reparative changes in periprosthetic fractures bone tissue of the femoral component: hyperplasia of osteoblasts located along the forming bone trabeculae. Staining with hematoxylin and eosin. Magnification × 200

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6.
Fig. 6. Reparative changes in periprosthetic fractures bone tissue of the femoral component: enchondral ossification. Staining with hematoxylin and eosin. Magnification × 200

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7.
Fig. 7. Reparative changes in periprosthetic fractures bone tissue of the femoral component. In muscle tissues: pronounced interstitial edema, areas of fibrosis with uneven lymphocytic infiltration mixed with histiocytes and leukocytes. Staining with hematoxylin and eosin. Magnification × 100

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8.
Fig. 8. Reparative changes in periprosthetic fractures bone tissue of the femoral component: productive inflammation in adipose tissue with clumps of macrophages

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