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Vol 27, No 3 (2020)

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Original studies
Treatment of an extensive acetabular defect in a patient with aseptic instability of a total hip arthroplasty
Aleksanyan H.A., Chragyan H.A., Kagramanov S.V., Zagorodniy N.V.

The aim of the study is to demonstrate, using a clinical example, the possibility of treating a patient with a severe acetabular defect by performing a one-stage revision arthroplasty using an individual design.

Materials and methods. A 45-year-old female patient was admitted with complaints of pain, limitation of movement in the right hip joint, and gait disturbance. From anamnesis at the age of 5 years, reconstructive operations of the hip joints were performed. In 1991, CITO performed primary total arthroplasty of the right hip joint with an endoprosthesis from ESKA Implants. In 1998, due to the instability of the acetabular component of the total endoprosthesis of the right hip joint, revision arthroplasty was performed, and the cup was placed with a cement fixation. In 2001, for left-sided dysplastic coxarthrosis, primary total arthroplasty of the left hip joint was performed. In 2012, due to the instability of the total endoprosthesis of the left hip joint, revision arthroplasty was performed using an ESI anti-protrusion ring (ENDOSERVICE) with a cement cup and a Zweimüller-type femoral component; the femur defect was repaired using a fresh frozen cortical graft. In October 2019, instability of the total endoprosthesis of the right hip joint was revealed, for which revision endoprosthetics was performed using an individual acetabular component.

Results. The HHS index before revision arthroplasty was 21 points, after 1 month after surgery — 44 points, after 3 months after surgery — 65, after 6 months — 82. Quality of life was assessed according to the WOMAC scale: before surgery — 73 points, after 1 month after surgery — 54 points, after 3 months — 31, after 6 months — 15 points. At the time of the last consultation, the patient moves with a cane, lameness persists, associated with scar reconstruction and atrophy of the gluteal muscles.

Conclusion. The use of individual structures allows to restore the support ability of the lower limb and the function of the hip joint in the case of an extensive defect of the pelvic bones of the pelvic discontinuity type.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(3):60-66
Experience with the use of bioactive calcium phosphate-coated implants in multicomponent traumatic damage to the hip joint
Grin A.A., Markov A.A., Danilova A.V., Sergeev K.S.

Objective. To study the effectiveness of using implants with a bioactive calcium-phosphate coating on the example of treating a patient with combined fractures of the acetabulum and the neck of the femur.

Materials and methods. A 52-year-old patient, injured as a result of a traffic accident with multicomponent damage to the right hip joint (transcervical fracture of the femoral neck and a high two-column fracture of the acetabulum). Osteosynthesis of the femoral neck fracture is made by three cannulated screws with a calcium-phosphate coating (patent of the RU No. 81427). For the osteosynthesis of the acetabular fracture, a reconstructive plate with a calcium-phosphate coating was used (patent of the RU No. 113945).

Results. Despite the heavy, multi-component destruction of the hip joint, consolidation of the fractures ensued. The remote result is tracked for 10 years. On the score scale of the functional results Harris 89 points, the result is rated as good.

The conclusion. The use of imantates with bioactive calcium-phosphate coatings from hydroxyapatite promotes activation of reparative processes in the region of fractures.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(3):67-72
Surgical treatment of locally advanced undifferentiated spindle cell paravertebral soft tissue sarcoma. Case report
Zagorodnii N.V., Karpenko V.Y., Berchenko G.N., Karasev A.L., Zelyanin A.S., Akhpashev A.A., Lysenko I.S., Iluridze G.D.

Abstract: Soft tissue sarcomas are a rare heterogeneous group of malignant tumor of different origin. The small quantity patients with this diagnosis leads to a lack of scientific data on the treatment of such patients. This article presents a clinical case of a patient with spindle-cell paravertebral sarcoma of soft tissues of pelvic localization, who get surgical treatment in the volume of reconstructive plastic surgery with endoprosthesis of the sacroiliac joint.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(3):73-78
Modern aspects of the treatment of Koenig’s disease in children
Vorotnikov A.A., Airapetov G.A., Vasyukov V.A., Yagubov V.G.

Relevance. Koenig’s disease, or osteochondritis dissecans of the knee joint, has been known since the end of the 16th century. The incidence is high (18-30 cases per 100 thousand of the population), while there is no common opinion on the management tactics and the treatment method for this pathology. Incorrect treatment choice as well as the lack of active management tactics provokes inevitably the transformation of primary pathology in early deforming arthrosis, followed by a pronounced decrease in joint function and the working capacity of an adult patient.

Material and methods: electronic scientific library PubMed, SciVerse (Science Direct), and Scopus were the open Internet tools we searched for literature sources. For data search we used following keywords: dissecting osteochondritis, Koenig’s disease, osteochondritis dissecans. The article presents the main results in the publications of domestic and foreign experts with an emphasis on the diagnosis and treatment of dissecting osteochondritis. In some cases, their own comments about the diagnosis and treatment are made.

Conclusion. In our opinion, the surgical objectives are to restore the congruency of the articular surfaces by improving vascularization of the affected area, tight fixation of the unstable fragment and protecting the supporting part of the loaded condyle section in the postoperative period. Due to the rarity of such a pathology and the lack of research with a high level of evidence base, further development of treatment methods is actual.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(3):79-86
Anterior stabilization of spine column in the staged surgical treatment of patients with fractures of thoracic and lumbar vertebrae with low bone mineral density
Afaunov A.A., Basankin I.V., Takhmazyan K.K., Giulzatyan A.A., Mukhanov M.L., Chaikin N.S.

Aim. To determine the clinical effectiveness of anterior stabilization in the surgical treatment of patients with traumatic injuries of the thoracic and lumbar spine with reduced bone mineral density.

Materials and methods. The study included 238 patients with thoracic and lumbar vertebral fractures with reduced bone mineral density (BMD). The age of patients is from 48 to 85 years. There are following types of fractures according to F. Magerl (1992): A1.2, A1.3, B1.2, B2.3. BMD of the vertebrae was decreased (T-score from –1.5 to –3.5).

Results. All patients underwent short segment transpedicular fixation (TPF) with four-screw systems. In group 1 were included 68 patients who underwent TPF without cemented augmentation of screws. Group 2 included 170 patients who underwent TPF reinforced with a cement. Both groups were divided into 2 subgroups. Subgroup 1.1 included patients, which were operated on in two stages. The first stage is TPF. The second stage is the anterior stabilization. Subgroup 1.2 included patients who underwent only TPF. Patients in group 2 were divided into two subgroups in a similar way. The results and complications according to clinical and spondylometric criteria were studied. Correlation analysis was performed between surgical technique, surgical tactics and the treatment results in the four selected subgroups. The observation period is at least 2 years.

Conclusion. 1. When using TPF with cement augmentation for the treatment of patients with fractures of the thoracic and lumbar spine with reduced BMD, the anterior stabilization of injured spinal motion segment as a second stage of surgical treatment does not provide clinical advantages compared to the use of only TPF with cement augmentation. 2. In case of cementless TPF in patients with reduced BMD, anterior stabilization of the injured spinal motion segment is necessary. Only when anterior stabilization is performed, the stability of fixation is ensured. It is sufficient to preserve the anatomical relationships restored during the operation and functional adaptation of patients in the long-term period after surgery.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(3):5-15
Surgical treatment of patients with sagittal imbalance of degenerative etiology: a comparison of two methods
Baykov E.S., Peleganchuk A.V., Sanginov A.J., Leonova O.N., Krutko A.V.

Purpose. Compare the clinical and radiological results of treatment of patients with spinal deformities operated on using the PSO method and corrective fusion in the lumbar spine.

Materials and methods. Retrospective monocenter cohort study. The data of 42 patients were analyzed. PSO (group I) was performed in 12 patients; 30 patients had a combination of surgical methods (group II) with mandatory ventral corrective spinal fusion at levels L4-L5, L5-S1. Clinical and radiological parameters were evaluated during hospitalization and at least 1 year later.

Results. Postoperative hospitalization in group I — 32.5 ± 7.4 days, 27.1 ± 7.4 in group II (p = 0.558758). The duration of the operation in group I was 402.5 ± 55.6 minutes, in group II 526.0 ± 116.2 minutes (p = 0.001124); blood loss 1862.5 ± 454.3 ml versus 1096.0 ± 543.3 ml (p = 0.000171). In both groups, significantly improved clinical and radiological parameters after surgery and after 1 year (p < 0.05). In group II, as compared with group I after surgery and more than 1 year: lower back pain according to VAS (p = 0.015424 and p = 0.015424); below ODI after 1 year was (p = 0.000001). In group I, compared with group II after surgery and after 1 year, SVA is less (p = 0.029879 and p = 0.000014), lumbar lordosis is higher (p = 0.045002 and p = 0.024120), LDI is restored more optimally (p = 0.000001 and p = 0.000002), the GAP is lower (p = 0.005845 and p = 0.002639). The ideal Russoly type is restored more often in patients of group II (p = 0,00032). Complications in group I were noted in 12 (100%) patients, in group II — in 13 (43.3%) patients (p = 0.001).

Conclusions. In multistep surgical treatment compared with PSO, the anterior corrective interbody fusion L4-L5, L5-S1 reliably better and more harmoniously restores the sagittal balance parameters, has significantly lower volume of intraoperative blood loss, fewer perioperative complications and significantly improves the quality of life of patients.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(3):16-26
Treatment of suprascapular neuropathy
Orletskii A.K., Timchenko D.O., Gordeev N.A., Krylov S.V.

Aim. Evaluation of the results of surgical treatment of patients with neuropathy of the suprascapular nerve.

Materials and methods. In the department of sports and ballet injury of CITO them N.N. Priorov in 2013–2014 11 arthroscopic decompression of the supramandular nerve were performed. All patients underwent radiography and MRI of the shoulder joint and electroneuromyography of the brachial plexus.

Results. After decompression, all patients underwent repeated electroneuromyography 2 months after the operation, then according to indications. In all cases, an increase in M-response was noted. A complete recovery of clinically and an increase in the M-response of more than half the norm (contralateral) and more to the normal value was observed after 5–8 months.

Conclusion. The use of modern minimally invasive methods of surgical etiotropic treatment of the neuropathy of the suprascapular nerve helps to achieve, as a rule, good and excellent results, even in old cases.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(3):27-31
First metatarsophalangeal joint chondroplasty using the autologous matrix-induced chondrogenesis in treatment of patients with hallux rigidus. Analysis of immediate and medium-term results
Nurmukhametov M.R., Makarov M.A., Bialik E.I., Makarov S.A., Khrennikov Y.B.

Introduction. To date, there is no single approach to the surgical treatment of hallux rigidus. In turn, it is known that in the presence of bone-cartilaginous defects in knee, hip and ankle joints, the autologous matrix-induced chondrogenesis is quite successfully used. In this regard, we have proposed to use this technique in patients with hallux rigidus.

The aim of the study was to evaluate the clinical efficacy of the 1st MTP joint chondroplasty using the induced chondrogenesis technique in patients with HR, to analyze the immediate and medium-term results of the operations in terms of pain and function.

Materials and methods. The 1st MTP joint chondroplasty has been performed in 21 patients with hallux rigidus. Before the surgery the range of motion (ROM) in 1st MTP joint was measured; the foot condition was evaluated using such scales as VAS of pain, AOFAS, VAS FA. The 1st MTP joint chondroplasty was performed using the technique of the induced chondrogenesis with collagen matrix. The results of surgical treatment were evaluated within 3, 6 and 12 months after surgery.

Results: 3 months after the operation, a significant decrease in pain, an increase in ROM in 1st MTP joint and an improvement in the foot function were observed. Subsequently, a moderate positive dynamic was observed.

Conclusion: the results of the operations showed that the 1st MTP joint chondroplasty can be an effective method of surgical treatment, which allows to relieve pain and significantly improve the quality of life of patients with hallux rigidus, both young and elderly. Also, this technique can be used in the treatment of patients with rheumatic diseases of the low activity or remission.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(3):32-41
Reconstructive surgery for locally advanced malignant tumors periacetabular region
Zagorodnii N.V., Karpenko V.Y., Karasev A.L., Zelyanin A.S., Lysenko I.S., Iluridze G.D.

The article presents the history of development and improvement of various methods of surgical treatment of patients with tumor lesions of the pelvic bones, as well as modern types of operations in this category of patients. Based on the analysis of literature data of domestic and foreign sources are considered possible complications and their causes, summarizes the surgical and oncologic results of the most relevant studies devoted to this subject.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(3):42-51
Calcium phosphate and composite materials functionalization of bioactive agents for its target delivery to the bone
Kuvshinova E.A., Petrakova N.V., Sergeeva N.S., Sviridova I.K., Kirsanova V.A., Ahmedova S.A., Karalkin P.A., Teterina A.Y., Komlev V.S.

Aim of the study. The development of the method of octacalcium phosphate (OCP) and mineral-polymer composite material functionalization with biological agents (human platelet lysate (PL) growth factors and antibiotic vancomycin) by the biomimetic coprecipitation principle technique.

Materials and methods. The OCP and the mineral-polymer composite matrices (sodium alginate / gelatin / OCP) functionalization was obtained by biomimetic coprecipitation of calcium phosphates and the bioactive molecules on their surface. The materials structure was examined by electron microscopy. The functionalization efficiency was determined by measurement of the incorporated compounds in solution, as well as by analysis of their release over the 8 days. The antimicrobial activity of vancomycin functionalized samples was evaluated by in vitro disk diffusion method against the Staphylococcus aureus strain.

Results. The evaluation of incorporated molecules release showed that the OCP functionalization with vancomycin is more effective than PL. The antibiotic release had continued for three days, while PL growth factors — only for 30 minutes. The incorporated into a composite matrix vancomycin was completely released within 24 h. In vitro study of the functionalized composite samples showed growth delay of the Staphylococcus aureus strain in dependence on antibiotic content.

Conclusion. The developed method of drug incorporation during biomimetic precipitation allowed to create target delivery system which transfer antibiotic to the bone defect.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(3):52-59
In memory of Batpenov Nurlan D.

On July 15, 2020, at the age of 71, Nurlan Dzhumagulovich Batpenov, founder and first director of the Scientific Research Institute of Traumatology and Orthopedics of the Ministry of Health of the Republic of Kazakhstan, Doctor of Medical Sciences, Professor, Academician of the National Academy of Sciences of the Republic of Kazakhstan, laureate of the State Prize of the Republic of Kazakhstan in field of science and technology, honored worker, chief freelance traumatologist-orthopedist of the Ministry of Health, president of the Kazakh Association of Traumatology-Orthopedists, Traumatologist-Orthopedist of the highest category.

N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(3):87-87

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