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Vol 30, No 2 (2023)
- Year: 2023
- Articles: 12
- URL: https://journals.eco-vector.com/0869-8678/issue/view/7199
- DOI: https://doi.org/10.17816/vto.2023302
Original study articles
Functional states of the hip joint in the early postoperative period with direct anterior arthroplasty with a skin incision «bikini»
Abstract
BACKGROUND: The prevalence of coxarthrosis at age of 18 years and older has reached 13% in recent years. Total hip arthroplasty is considered the gold standard for the treatment of late-stage coxarthrosis and other hip pathologies. Due to the more frequent intervention performed in recent years and increasing patient expectations, the choice of optimal surgical access will improve the outcomes of the treatment method. However, given the lack of statistical data on the qualitative difference in the postoperative condition of patients using different surgical accesses during hip arthroplasty, there is no consensus on the optimal access choice.
AIM: To carry out a comparative assessment of the hip joint functional states in the postoperative period after endoprosthesis using direct anterior and anterolateral accesses.
MATERIALS AND METHODS: The study included 163 patients with coxarthrosis, 71 men and 92 women, who were subsequently divided into 2 groups: the comparison and the main one. To investigate the effectiveness of the proposed approach to endoprosthesis, the results were evaluated by dynamic assessment of joint function using the Barthel scale, the Stand and Walk test, the Leken algo-functional index, the Harris Hip Score scale, and the Health Assessment Questionnaire. The Statistical analysis was performed using StatSoft Statistica 10 and Microsoft Excel 2016 software packages. Intergroup comparisons of quantitative indicators were performed using the Mann-Whitney rank test in case of nonparametric distribution of indicator values and/or significant difference in groups.
RESULTS: The findings showed that in the postoperative period, the use of direct anterior access in hip arthroplasty was associated with faster recovery of hip joint functionality and shorter inpatient stay compared with anterolateral access, which was confirmed by statistically significant intergroup differences.
CONCLUSION: The clinical efficacy from using the direct anterior access can be seen in statistically significantly (p <0.05) higher scores on the Barthel self-care scale, the results of the "Stand up and walk" test 2–6 weeks after surgery, as well as better dynamics of the Harris Hip Score, Leken Index, and Health Assessment Questionnaire 1–3 months after hip arthroplasty.
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Long-term results of periprosthetic infection prevention and treatment in oncoorthopedics
Abstract
BACKGROUND: Endoprosthesis after bone and joint resection is the treatment of choice for patients with malignant bone tumors, especially in case of a favorable oncological prognosis. Endoprosthesis bone site infection and relapse associated with the underlying disease are important complications that are difficult to treat. The development of periprosthetic infection leads to the loss of functional potential after the end of this complication treatment and worsens oncologic prognosis.
AIM: To study and improve the long-term results of treatment in patients with diagnosed periprosthetic infection who underwent oncologic endoprosthesis, to develop a preventive complex of measures aimed at reducing periprosthetic infection.
MATERIAL AND METHODS: The study included 1292 patients with primary bone sarcomas, soft tissue sarcomas, metastatic and benign bone tumors who underwent 1671 primary and recurrent endoprosthetic replacements between January 1992 and January 2020. A total of 677 (52.4%) men and 615 (47.6%) women participated in the study. Patients ranged in age from 10 years to 81 years. Oncologic endoprosthetics were performed in 886 (68.6%) patients with primary malignancies, 144 (11.1%) with metastatic bone lesions, and 262 (20.3%) with benign neoplasms. The mean follow-up period after endoprosthetic replacement with various bone segments was 82.8 months (0-335.7 months).
RESULTS: The incidence of periprosthetic infection during the entire follow-up period in primary endoprosthesis was 7.1%, and in repeat endoprosthesis — 6.2%. The recurrence rate of endoprosthesis infection in primary endoprosthesis during the observation period was 83%, in repeat endoprosthesis — 61.5%. The frequency of periprosthetic infection was reduced by changes in the endoprosthetic strategy. The prevalence of early (type IVA according to ISOLS 2013) infectious complications (15 and 11.9%) over late (type IVB) complications (5 and 4.4%, respectively) in both primary and repeat arthroplasty was higher. Staphylococcus aureus was most frequently identified after primary endoprosthetic replacement (38.1%) and Staphylococcus epidermidis was most commonly verified after repeat endoprosthetic replacement (53%). Two-stage reendoprosthesis was used most often to treat periprosthetic infection: after primary endoprosthesis — in 58.3% of cases, after repeat endoprosthesis — in 65.4%. The preventive measures developed in the study made it possible to reduce the incidence of the endoprosthesis site early infection by 15.3% in primary endoprosthesis and by 7.1% in repeat endoprosthesis.
CONCLUSION: The perioperative antibiotic prevention regimen should provide a steady antibiotic concentration during the entire course of surgery and the time associated with the highest risk of endoprosthesis site early infection (extended antibiotic treatment up to 5 days), which allows to reduce the wound microbial contamination to a safe level. The findings suggest that two-stage reendoprosthetic replacement remains the main treatment option for periprosthetic infection.
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Morphometric scale of readiness of the limb stump for prosthetics and assessment of the technical condition of the operated prosthesis
Abstract
BACKGROUND: There are currently no quantitative criteria for the completion of the upper and/or lower limb stump after amputation or disarticulation for prosthetics, even though this is a key moment at the start of a patient's stage of medical rehabilitation and social adaptation. Also, there is no scale for assessing the technical condition of a prosthetic limb that is already in use.
OBJECTIVE: To develop evaluation scales to assess the morphometric stump readiness for prosthetics and the technical condition of the prosthesis in use.
MATERIALS AND METHODS: The current standards and Interstate Standard concerning the issues of prosthetics after limb amputation in the Russian Federation and in the world, as well as medical documentation containing information recorded during limb amputation or disarticulation were analyzed.
RESULTS: The developed scales for stump condition assessment and technical condition of a prosthesis in use will allow to determine the final criteria of stump readiness for prosthetics and timely eliminate technical prosthesis defects or replace it, thus maintaining the patient's social activity without forced interruptions.
CONCLUSION: In this study we significantly expanded the assessment scale of the limb stump morphometric readiness and detailing for prosthetics and the technical condition of the prosthesis in use in comparison with the existing Interstate Standard; quantitative criteria were introduced, allowing the traumatologist to have a clear algorithm of actions both when treating patients immediately after limb amputation (disarticulation) and in terms of assessing the condition of the prosthesis in use; scales suitable for implementation in medical electronic document management have been developed.
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The method of integral evaluation of the efficiency of the neurosurgical clinic based on the assessment of the degree of achievement of key performance indicators
Abstract
BACKGROUND: The efficiency of a modern clinic, including neurosurgery, is traditionally assessed through the prism over a set of indicators. However, a common approach to assessing the effectiveness of medical and preventive institutions and a corresponding set of universal private indicators that allow comparing them with each other are not available.
OBJECTIVE: To evaluate the efficacy of a neurosurgical clinic through a quality indicator perspective using the goal attainment scale.
MATERIALS AND METHODS: Eleven key indicators (target categories) were selected for the integral results assessment of the neurosurgical clinic. Calculated indicators were evaluated using a special scale — the goal achievement scale developed by Kiresyuk and Sherman.
RESULTS. Based on continuous analysis conducted on the key work parameters in the Neurosurgery Center from 2014 to 2021, the target indicators were “weighed” and indicators ("0") were formed, relative to which the degree of goal achievement was subsequently assessed (from "+2" to "–2"). The level required to achieve the targets was calculated in the web application. The results of the clinic's work in 2021 have significantly improved by some indicators (number of performed operations, postoperative mortality, respiratory and urinary system infections, surgical wound infections (meningitis) per 100 ICU patients with severe complications), while the indicators of surgical activity, bloodstream infections and the number of revisions have deteriorated.
CONCLUSION. Qualitative and quantitative indicators of a modern clinic can be systematically analyzed to assess the effectiveness of its work using a scale for goal achievement. This scale integration into a web application makes it possible to easily and quickly obtain information about the degree of goal achievement in a real-time mode and makes it possible to conduct external benchmarking.
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Changes in neuromuscular, skeletal and movement-related functions in children with dorsalgia during medical rehabilitation
Abstract
BACKGROUND: Understanding the epidemiology of pain and what predisposes the pain in adulthood, it is important to study it in children, to determine the factors responsible for the initial episodes occurrence of initial episodes. At the present time, heterogeneity in the research methodology makes it impossible to compare the findings. A significant indicator is the health component of Body functions, Neuromuscular, skeletal and movement-related functions, which is assessed in accordance with the International Classification of Functioning of the ICF.
AIMS: To determine the significance of the Body functions components, to study and systematise their change in Neuromuscular, skeletal and movement-related functions in children with dorsalgia during medical rehabilitation.
MATERIALS AND METHODS: We observed 309 children with back pain: 150 boys (48.5%) and 159 girls (51.5%). Patients' mean age was 11.9±5.1 years, the minimum age — 4 years, the maximum age — up to 20 years in girls, 21 years in boys, in accordance with the age periodization accepted in our country.
RESULTS: Muscle function examination (b7303, b7305 (a), b7305 (b), b7306 (a), b7306 (b), b7401 (a), b7401 (b), b7401 (c), b7401 (d), b7401 (e), b7401 (h), b7402) revealed significant impairments in all groups. During the medical rehabilitation process in the main groups, a steady positive change in these indicators was continuously observed, which in a year reached the ICF determinant — absence of violations.
CONCLUSIONS: The health components of Body function scores in Neuromuscular, skeletal and movement related functions in children with dorsalgia are an important clinical tool for selecting rehabilitation programs and evaluating their effectiveness.
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SCIENTIFIC REVIEWS
Pathogenetic and clinical aspects of osteoarthritis and osteoarthritis-associated defects of the cartilage of the knee joint from the standpoint of understanding the role of the subchondral bone
Abstract
The article presents an analytical review on modern ideas about the osteoarthritis pathogenesis based on the findings regarding the subchondral bone and its importance in the development of this disease. It is shown that the data of numerous studies in recent years reveal more and more evidence demonstrating the primacy of pathological changes in the subchondral bone in the development of osteoarthritis and its progression. The vast majority of scientific papers confirm the fact that hyaline cartilage and subchondral bone tissue are a single morphofunctional biocomposite with an interdependent system of biochemical connections and molecular signaling, as well as correlative reactions to stressful mechanical loads. The authors analyzed in detail the mechanisms of cellular and molecular interaction in the system "hyaline cartilage — subchondral bone" in the development of osteoarthritis, vividly demonstrating the active and priority involvement of subchondral bone tissue in the debut and maintenance of the destructive-dystrophic process. The necessity to leave the chondrocentric model of osteoarthritis pathogenesis and the expediency to revise the points of application of therapeutic measures in patients with knee joint osteoarthritis are discussed. The current methods of surgical treatment of knee joint osteoarthritis are critically reviewed from the perspective of their pathogenetic orientation. The authors discuss the relevance in developing the concept of organ-preserving surgery in destructive-dystrophic joint lesions, which should be based on the findings describing the role and significance of subchondral and metaphyseal bone tissue in the above pathologic processes.
219-231
Treatment of intra-articular fractures and fracture-dislocations fingers of the wrist in acute and long-distant periods
Abstract
This review is devoted to the problem of treating patients with intra-articular fracture dislocations affecting the finger proximal interphalangeal joint and their consequences. Although these traumas are quite common among hand injuries, there is currently no single universal approach to their treatment. The review was conducted using literature databases, PubMed and eLibrary. The work highlights the joint anatomy, injury mechanisms, diagnostic methods, classification variations, and treatment methods.
233-244
Os odontoideum of C2 vertebra: History and current options to treatment. Literature review. Part 2
Abstract
The second part of a literature review is presented on a rare pathology of the craniovertebral region, the os odontoideum of the C2 vertebra. This review is non-systematic and was conducted using the databases and search resources: PubMed, Google Scholar, and eLibrary. The second part of this literature review describes historical, including conservative, treatment tactics for patients with os odontoideum, peculiarities of preoperative planning and preparation, as well as modern techniques and options for surgical treatment.
245-258
Clinical case reports
Experience of use of the individual cutting block «5 in 1» using total knee arthroplasty
Abstract
BACKGROUND: Total knee arthroplasty is the most progressively developing direction in the modern orthopaedic world. With the new visualization technologies, a whole new field of computer-assisted orthopaedic surgery has emerged. Generally, three groups can be distinguished in computer-assisted orthopedic surgery. The 1st group — the use of individual resection blocks, templates or guides — remains the most relevant today. However, the use of currently existing individual resection blocks, according to the literature, has contradictory results.
CLINICAL CASES DESCRIPTION: This work presents the author's developed technique of a new preoperative 3D modeling for total knee arthroplasty using individual resection blocks. The paper presents a clinical case demonstrating the effectiveness of the new technique.
CONCLUSION: The strategy CT+MRI, in our opinion, is the optimal solution not only for competent preoperative planning of total knee arthroplasty, but also for designing individual resection blocks. Our individual resection blocks allowed us to improve the accuracy of total knee arthroplasty.
199-208
The use of an individual acetabular component for acetabular defect: a clinical case
Abstract
BACKGROUND: The incidence of total hip replacements is increasing every year. Acetabular defects are becoming more frequent, with Paprosky type IIIA and above becoming more common. Recently, customized 3D-printed constructs have been used to remodel severe defects. We wanted to demonstrate the possibility of treating a patient with a severe acetabular defect by performing a one-stage revision endoprosthesis using a customized design.
CLINICAL CASES DESCRIPTION: A 69-year-old patient underwent primary total hip replacement of the right hip joint with a Biomet endoprosthesis for coxarthrosis in 2010. In 2011 — on the left side with a Zimmer endoprosthesis. In 2013 — revision endoprosthesis of the right hip joint due to instability was preformed. In the postoperative period, there were repeated dislocations with subsequent closed repositioning. In 2015, revision endoprosthetic replacement with a Burkh-Schneider antiprotrusion ring was done for recurrent dislocation. In november 2017, she was diagnosed with instability of the right total hip joint, for which she underwent revision hip replacement with a customized acetabular component.
HHS score before revision arthroplasty was 18 points, 1 month after surgery — 75 points, after 3 months — 65, after 6 months — 82, after 4 years — 74. Quality of life was assessed using the WOMAC scale: 92 points before surgery, 38 points 1 month after surgery, 31 points in 3 months, 15 points in 6 months, and 35 points in 4 years. As of the last visit, the patient moves with a cane, and still has a limp due to scar remodeling and gluteal muscles atrophy.
CONCLUSION: In case of severe acetabular defects, the use of individual components allows achieving reliable "implant–bone" fixation, which leads to improved functional results. However, in chronic pelvic bone integrity defects, the use of an individual acetabular component does not always achieve reliable stabilization. All existing methods for solving this problem are currently ambiguous and require further improvement.
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Anniversary
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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор). Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77-76249 от 19.07.2019.