Vol 1, No 4 (1994)


Certain problems of total joint replacement

Shaposhnikov Y.G.


On the basis of the analysis of home and foreign experience, the author discusses the certain most actual problems of total joint replacement and the ways of their solution, i.e. search of new sufficiently strong and, in the same time, biologically inert materials for the production of joint implants; modification of the implant components surface in order to ensure their maximum biological compatibility and optimum conditions for the bone tissue ingrowth; improvement of the tribologic characteristics of the friction couple in the mobility unit; elaboration of bone cement. High social and economic significance of joint replacement is emphasized.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):3-5
pages 3-5 views

Our experience with total hip joint replacement

Kuzmenko V.V., Yeremin D.I., Chekashkin Y.I., Yakushin A.A., Karpukhin A.O., Olenin O.V.


The paper analyzes 286 surgeries in 245 patients for total replacement of the hip joint with currently available implants. Indications, preoperative preparation, specific features of surgical techniques, and postoperative outcomes are given in detail. Attention is drawn to the necessity of comprehensive examinations of patients by employing up-to-date tools to prevent postoperative complications. Outcomes were followed up in the periods over a year.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):5-10
pages 5-10 views

Hip joint endoprosthesis with the Movshovich-Gavryushenko prosthesis having a reserve friction mechanism and a changeable cervical diaphysial angle

Movshovich I.A.


One of the main reasons for endoprosthesis instability (loosening) is a high friction coefficient in the mobility point. The tribological studies made at the Laboratory of Polymers, Central Institute of Traumatology and Orthopedics, have indicated that greasing the prosthesis mobility angle with bone marrow shows a 2-3-fold reduction in the friction coefficient. On this basis, a new type of the Movshovich-Gavryushenko hip joint endoprosthesis having a reserve friction mechanism was designed. In the prosthetic crus, neck, and head, a canal was formed, along which bone marrow drops entered the mobility node throughout the endoprosthetic functioning period. The endoprosthesis is also noted for its changeable cervical diaphysial angle due to the fact that there are three replaceable necks. This enables a surgeon to make the head have its varus or vagus position, as well as to place it in the ante- or retroversion position. Endoprosthesis by mean of the model was successfully performed in 146 patients, as shown by a 5-year follow-up.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):10-14
pages 10-14 views

Hip joint implanting

Buachidze O.S.


The paper provides some experience with hip joint endoprosthesis with Poldi and Beznoska implants, Czechia, used in 210 patients (235 operations). Total and cervicocapital endoprostheses were implanted in 193 and 42 cases, respectively. The indications for total and unipolar joint replacement were severe Stage III coxarthrosis, aseptic necrosis of the head of the femur, pseudoarthrosis of its neck, subcapital fractures with severe limb dysfunctions and persistent pains. Positive results (complete recovery of joint movements and limb load) were noted in 93% of patients in the follow-up periods of 6 months to 18 years. The complications were seen as follows: wound suppuration in 4 patients, aseptic instability in 4 (they all were reoperated), relaxation of a total implant and partial protrusion of the head of a unipolar implant in 6 patients.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):14-17
pages 14-17 views

Replacement of extensive bone defects in patients with locomotor system tumors

Makhson A.N.


The paper discusses the problem in replacing extensive bone defects after adequate resections in patients with locomotor system tumors, defines a concept of an adequate operation, and provides an original classification of osteotumors by the extent of a tumorous process. After extirpation of the clavicle (including resection of the manubrium sterni and the first rib), scapulectomy, inter-scapulothoracic, pelvic, and proximal fibular resections, the author does not replace bone defects, without deteriorating the surgical functional outcomes. In 135 patients, defects were replaced by variously designed endoprostheses (in 23 of them this was done after total removal of the femur or humerus). Postendoprosthetic complications developed in 14 patients: early suppuration (n = 3), metallosis and late suppuration (n = 3), endoprosthetic fracture (n = 5), and intraoperative bone fracture (n = 3). Bone fracture occurred while mastering the procedure and failed to affect therapeutical functional results. In extensive long bone diaphysial defects and combined bone and soft tissue defects, the author used autografting on micro-vascular anastomoses in 34 patients or defect replacement in the Ilizarov apparatus in 8 patients.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):18-21
pages 18-21 views

Specific features of complications of osteoplastic surgeries following chemical and radiation therapies of patients with malignant bone tumors

Bizer V.A., Kurilchik A.A.


The paper analyzes the nature and specific features of complications following osteoplastic surgeries performed in various periods after radiation and chemical therapies. Early complications did not depend on the radiation dose and the postradiation therapeutical interval, which suggests that they are closer related to the operation itself. In late complications, there is a relationship between their frequency and the postradiation interval. There are differences in the nature of complications and their natural history, which are accounted for the specific impact of ionizing radiation on soft tissues. In particular, there is a late manifestation of a radiation reaction which runs acutely and which is hardly differentiated from routine inflammation. The parameters of longevity after organpreserving surgery cannot serve as criteria for survival rates since they are obtained in examining random samples.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):21-24
pages 21-24 views

Some aspects in the treatment of patients with a suppurative process after joint implanting

Makhson N.Y., Pokryvalov A.A.


Attention is concentrated on the basically varying nature of early and late suppurative complications after implanting and hence on different approaches to treating deep suppurative processes. In early deep suppurations, timely intensive care permitted the authors to eliminate suppurative complications in 67.8%, by preserving the implant. In late suppurations associated with metallosis, the implant cannot be preserved, it is necessary to treat not only a deep suppuration, but also metallosis.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):24-26
pages 24-26 views

Fractures of the stems of Sivash total hip implants

Sherepo K.M.


Six hundred seventy-three total hip replacements by Sivash (free material) resulted in 21 fractures of the implant stem (3,12%) in the period from 3 to 20 years after operation. Biomechanical study as well as the surgical findings allowed the author to assume that the probability of the stem fractur in the stable implant is higher than in unstable one. Metal — and fractographic analysis the fractures are of the fatigue pattern. The promoting factors are the micropores in the structure of the metal and the facings during mechanical treatment of the implant. The surgical technique of prevision total hip replacement in case of the stem fracture is described.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):27-30
pages 27-30 views

Influence of various physical and mechanical factors on the fate of joint implant and its functional capacities

Gavryushenko N.S.


The artificial and natural joints are biomechanically adequate due to their similar technical characteristics. The tribological characteristics are responsible for joint mobility. With high material abrasion resistance, a low friction coefficient cannot be achieved without greasing. If the friction coefficient can be reduced to the level typical of a healthy joint (0.008—0.04), one can expect a relevant decrease in breaking forces resulting in the friction point from slip resistance. In this case the safety margin generated on cement fixation will be sufficient for the service life of an implant to be 2—3 times higher than the currently available (the Chanley joint implants serve as many as 30 years). With these occurring events, the demand will decrease for a small number of cementless fixation joint implants and their application will be associated only with contraindications for cement use.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):30-34
pages 30-34 views

The porous coating of joint implants as a factor of their stable fixation

Toshchev V.D.


To ensure effective biological fixation of the newly designed cementless hip joint implant, a macroporous material proposed to be used as a coating for the implant was studied. Eighty-five samples of the cylindrical implants produced via hot sintering from spherical titanium granules having different diameters were analyzed. Morphological, mechanical, and other findings revealed a rapid bone ingrowth into the sample pores and their firm biological fixation in the canine tubular bone. The selected material having optimal characteristics will be applied to the surface of the specially designed joint implant. Its pilot-designed model is manufactured to make initial clinical trials, followed by updating for applying the ball coating. The new joint implant macroporous coating with its improved geometry will enhance the fixation of the construction due to bone ingrowth, contribute to the rapid postoperative recovery of a patient’s full-load walking ability, and minimize the risk for aceptic loosening of the implant.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):34-38
pages 34-38 views

Conservative treatment of patients with Paget disease

Burdygin V.N., Rodionova S.S., Kolondayev A.F.


The paper deals with results of conservative treatment of 96 patients with Paget’s disease with the national drugs, such as calcitrin and xidiphone which affect osseous metabolism. Positive results were achieved in the clinical, X-ray, biochemical pattern of the disease in most patients. This makes it possible to recommend the drugs for treatment. The advantages and disadvantages of the agents are determined. The efficiency of xidiphone therapy is regarded to be the most beneficial. It is suggested that complications may develop and progress in some cases even when there are marked positive shifts, which dictates the necessity of continuous monitoring of patients.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):39-42
pages 39-42 views

Diagnostic value of zonography and coronary computed tomography in upper spinal disease and injuries

Vetrile S.T., Kolesov S.V., Morozov A.K.


The diagnostic potentialities of coronary computed tomography (CT) (23 patients) and zonography (25 patients) were evaluated by analyzing the results of examinations. Zonography is largely indicated in limited mobility of the neck. Coronary CT requires sufficient cervical mobility. The latter method has a high resolution and allows one to diagnose abnormalities undetectable during routine X-ray examination. Zonography and coronary CT substantially elevate the quality of diagnosis in various injuries and diseases of the upper spine.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):42-44
pages 42-44 views

Treatment of femur head dislocation fractures

Musalatov K.A., Silin L.L., Yakimov L.A., Farygin V.A.


The paper provides evidence for the fact that conservative therapy for femur head dislocation fractures is ineffective. It considers surgical techniques used in 12 patients, such as removal of small fragments (n=4), osteosynthesis of a large fragment on a pedicle (n=5), total joint implanting (n=3). Contraindications for each technique are defined. Despite many months’ postoperative joint unloading, 3 of the 7 patients examined in late periods developed aseptic femur head necrosis.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):44-46
pages 44-46 views

Two-stage treatment for old dislocation fractures in the Lisfranc and Chopart joints

Cherkes-Zade D.I., Do A.V.


Two-stage treatment of old dislocation fractures in the Lisfranc and Chopart joints is dealt with. At the first stage, a compression-distraction apparatus is applied to eliminate rough dislocations of the anterior, middle, and posterior parts of the foot, at the second stage, a partial arthrodesis is made along the line of the Lisfranc and Chopart joints instead of various wedge resections. A classification of the abnormality in question by the injury duration is proposed, which allows one to choose its management. Good and satisfactory late results were achieved in 96% of patients.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):46-48
pages 46-48 views

Blood components autotransfusion at the planned treatment of patients with orthopaedic diseases

Dorozhko І.G., Onoprienko G.A.


The authors elaborated the method of preservation of 2 doses of autoerythrocytic mass prior to the planned surgical interventions with the expected massive blood loss. During autoblood storing and preservation of 2 doses of erythrocytic mass the reinfusion of plasma to the patient was carried out thereby the circulating blood volume was restored in the volume up to 1000 ml. It provided the reduction of the requirement in donor blood by 89,2%. The method was effective at such surgical interventions as the total joint replacement (4), hip joint arthrodesis (7), subtrochanteric and intertrochanteric corrective osteotome (5), osteosynthesis of acetabulum fragments (50).

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):48-51
pages 48-51 views

Functional postoperative treatment of Achilles tendon subcutaneous tears

Mironov S.P., Vasiliev D.O.


The methods of postoperative functional treatment of Achilles tendon subcutaneous tears were elaborated and employed in the practical work of the Clinic of Sports and Ballet Injury, N.N. Priorov Central Institute of Traumatology and Orthopedics. These involved application of removable polyvic orthoses for postoperative immobilization. This type of the orthoses allows active controlled movements to be performed in the ankle joint. Postoperative functional treatment conducted in 14 patients significantly reduced the probability of development of long-term immobilization-associated complications and gave an opportunity to promptly revert to the initial level of physical activity.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):51-54
pages 51-54 views

Guy sutures fixative for the manual application of vascular sutures

Bliskunov A.I.


The device proposed is notable for its simplicity and compactness. It prevents mechanical stenosis of the vessel in the suture zone, considerably improves the convenience of the suturing (even when rotation of the vessel is not possible) and enables to make a vascular suture without any assistance.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):54-56
pages 54-56 views

What is walking? (orthopedist and biomechanic dialogue)

Belenky V.E., Kuropatkin G.V.


Orthopedist (referring to the biomechanist). We receive the results of our patients' walking studies from your laboratory. There are indicators that characterize this process. But I can't read your numbers. Your terminology is unfamiliar to me. It is clear to me that the most important thing for an orthopedist and trauma surgeon is to restore such an important process for a person as walking. But when I thought about this seemingly obvious position, I realized that I do not know the essence of this process. And then there are the results of your research that I don't understand. Tell me what walking is.
Biomechanic. Okay. I propose the following plan for our conversation:
- the temporal structure of the stride;
- the kinematics of the legs, pelvis and spine;
- external forces, leg support reactions, muscle work;
- the foot as a shock absorbing system;
- movement of body parts when walking in the frontal plane.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):57-61
pages 57-61 views


Modern methods of treatment of malignant tumors

Kotz R.


Attempts to avoid limb amputation upon detection of a malignant bone or soft tissue tumor were made by surgeons as early as the beginning of our century. One of them was related to plasty according to F. Sauerbruch: after resection of the femur, the tibia was moved upwards and placed in the musculocutaneous bed, resulting in a stump suitable for prosthetics. Tikhov and Linberg performed an extensive resection of the scapula and the proximal end of the humerus, preserving an "elongated" and unstable, but mobile upper extremity. Preservation of stability of the lower extremity by implanting tumor prostheses seemed to be the most reasonable. The first operation of this type was performed in the late 1930s by A. Moore for a gigantoclavicular tumor of the proximal femur. In the late 50s and early 60s, with the development of hip arthroplasty, the tendency to develop and implant special prostheses for patients with tumor diseases also intensified.

N.N. Priorov Journal of Traumatology and Orthopedics. 1994;1(4):62-68
pages 62-68 views

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