Vol 23, No 3 (2016)

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.

Results of the use of platelet-rich plasma (PRP) in patients with knee osteoarthrosis are presented. The study included 86 patients with I-III degree of knee osteoarthrosis (141 knee joints). All patients received 2 intraarticular injections of PRP with 14 days interval. Pain severity was assessed by visual analog scale in 6 and 12 months after treatment. The most significant positive dynamics was observed in patients with II degree - 50.6±2.32, 16.3±2.31 ( р <0,5) and 16.3±2.40 points initially and in 6 and 12 months, respectively. In III degree, despite the aggravation of symptoms by 12th month, the value of pain severity was better than the initial one, i.e. 79.3±2.32 vs 64.6±2.40 points initially and in 12 months, respectively (p<0.01). The received data confirm the efficacy PRP in treatment of early degrees of knee osteoarthrosis and perspective of future studies in that field.

Results of biochemical analysis of hip tissues (femoral head cartilage, proximal femur bone tissue, scarry tissue from hip cavity) and synovial fluid in 72 children and adolescents (aged 1 - 18 years) with congenital and pathologic hip dislocation, Legg-Calve-Perthes disease, femoral head aseptic necrosis and early coxarthrosis are presented. In tissue samples the content of hydroxyproline, hexuronic acids and hexoses was determined. In synovial fluid the content of hyaluronic acid, total protein and protein fractions, albumin, glucose and alkaline phosphatase activity was analyzed. It was detected that in congenital and acquired hip pathology the articular cartilage showed increased content of hydroxyproline, disorders of glycosaminoglycan metabolism and shift in glycoprotein metabolism indicative of destructive changes of basic cartilaginous tissue substance. Changes of synovial fluid chemical composition confirmed the disturbance of synovium permeability and were closely related to the clinical picture of metabolic-dystrophic changes in the joint.

To choose the optimum scheme of anticoagulant therapy for the prevention of thromboembolic complications after total hip arthroplasty 86 patients were examined. The patients were randomly divided into 3 groups. In group 1 (n=29) prevention of thromboembolic complications was performed by subcutaneous injection of enoxaparin (40 mg) started 12 hours before the surgery. In group 2 (n=28) enoxaparin (40 mg) was started 12 hours after surgical intervention. In those groups thromboprophylaxis with enoxaparin was continued during hospitalization period and at discharge the patients were given recommendations to take dabigatran etexilate up to 35 days. In group 3 (n=29) patients received oral dabigatran etexilate, 110 mg 1 - 4 hours after surgery, followed by 220 mg once-daily both at hospital and out-patient stage of treatment. The average duration of hospitalization made up 8.9±1.2 days. Minimum fibrinogen and D-dimer levels as well as maximum APTT values were observed in patients from group 3 on the 5th postoperative day. Thromboelastogram showed that on day 5 both plasma and platelet hypocoagulation were most expressed in 3rd group. Preoperative thrombodynamics showed high rate of clot growth and high percentage of spontaneous clots formation in all three groups that assumed initial hypercoagulation with maximum decrease of the frequency of spontaneous clots formation against the background of dabigatran prophylaxis. The lowest number (3,4%) of thromboembolic complications, i.e. distal thromboses, were observed in patients from dabigatran etexilate group. Assessment of anticoagulant prophylaxis costs showed a clear advantage of the 3rd group.

Results of retrospective analysis of the efficacy and safety of venous thromboembolic complications prevention using anticoagulants (low-molecular-weight heparins and rivaroxaban) in elderly (over 75 years) patients after hip arthroplasty are presented. Ninety four patients were divided into 2 groups (n=47) depending on the applied anticoagulant. Follow up period was 6 months after hospitalization. Asymptomatic thrombosis was diagnosed by duplex ultrasonography only in 1 (2.1%) patient from low-molecular-weight heparin group. No one case of either bleeding or hemorrhage was recorded. It is stated that rivaroxaban ensured effective thromboprophylaxis and safety after hip arthroplasty in elderly patients when no restrictions related to the use of low-molecular-weight heparin injections are present.

Mucopolysaccharidosis (MPS) is an orphan pathology characterized by polymorphism of clinical manifestations and development of typical skeletal changes. However in early childhood the clinical picture is not clear that leads to misdiagnosis and results in inadequate management of patients including unjustified surgical intervention. Early clinical and roentgenologic changes specific to mucopolysaccharidosis IV and VI that enable to suspect the pathology development, to perform required examination with compulsory confirmation by DNA testing results and prescribe vital enzyme replacement therapy as soon as possible are presented. Early diagnosis and initiation of etiotropic treatment and timely correction of the occurring pathology ensure prevention of fatal complications.