ANALYSIS OF THE SPECIFIC FEATURES OF THE USE OF PHYSIOTHERAPEUTIC METHODS IN PATIENTS WHO UNDERWENT ARTHROSCOPIC OPERATIONS ON THE KNEE JOINT IN 2018–2019 AT THE MEDICAL UNIT OF THE MINISTRY OF INTERNAL AFFAIRS OF RUSSIA IN THE REPUBLIC OF TATARSTAN

Background. Diseases of the musculoskeletal system are the most common cause of disability in the modern world, and the prevalence of these diseases is increasing at an alarming rate. Currently, various types of arthroscopic operations on the knee joint are performed – for meniscus damage (including meniscus suture), instability of the knee joint, damage to the cruciate complex, articular cartilage, patellar instability, free joint bodies, pathological folds, synovitis, knee arthrosis, and rheumatoid arthritis. Medical rehabilitation after arthroscopic surgery traditionally includes administration of nonsteroidal anti-inflammatory drugs, opioids, local anesthetics, therapeutic exercise using isometric active exercises, hydrokinesis therapy, and various physical therapy methods. Aim. Study of the use of physiotherapeutic methods in the treatment of patients who underwent atroscopic surgery on the knee joint in the physiotherapy department at the Ministry of Internal Affairs of Russia for the Republic of Tatarstan Clinical Hospital in 2018–2019. Material and methods. The frequency of prescription of therapeutic physical factors for patients who underwent arthroscopic surgeries on the knee joint at the physiotherapy department at the Medical Unit of Ministry of Internal Affairs of Russia for the Republic of Tatarstan Clinical Hospital in 2018–2019 was investigated. The patients were accordingly divided into two groups: in 2018, 37 patients were prescribed physiotherapeutic procedures, in 2019 there were 48 patients. The age of the patients in 2018 was (33,9±9,4) years, in 2019 it was (34,2±9,1) years. Statistica 6 software package by StatSoft was used for statistical processing. Differences were considered statistically significant at p<0,05. Results and discussion. Paraffin therapy, treatment using Nuga-Best bed, amplipulse therapy, UHF therapy, cryotherapy, oxygen cocktails containing medicinal herbs were prescribed with less frequency in the treatment of patients operated for knee joint injuries in 2018 than in 2019. Despite the proven effectiveness of whirlpool baths and darsonvalization in treating musculoskeletal disorders were not prescribed for the rehabilitation of patients who underwent atroscopic surgeries at the physiotherapy department of Medical Unit of Ministry of Internal Affairs of Russia for the Republic of Tatarstan Clinical Hospital in 2019. Conclusion. When rehabilitating patients who have undergone arthroscopic intervention on the knee joint, it is advisable to thoroughly consider the use of therapeutic physical factors to improve the operation of the physiotherapy department.

OUR EXPERIENCE IN TREATING PATELLAR DISLOCATION USING A MINIMALLY INVASIVE METHOD.

This article summarizes a little experience in the treatment of patellar dislocations by the arthroscopic method. In total, from 2018 to 2021, we performed 450 arthroscopic operations on the knee joint, of which the stabilization of the patella in case of dislocation was 7. Thus: in the case of primary traumatic dislocation, we performed 4 operations, with the usual - 3. Thus, carrying out arthroscopy, which allows you to restore the biomechanical axis with the elimination of patellar dislocation simultaneously or sequentially at the stage of treatment, allows you to get positive results.

Comparative evaluation of the use of a single and extended blockade of shoulder splitting at arthroscopic operations on the shoulder

In the last decade, there has been a steady increase in the number of arthroscopic operations on the shoulder joint. The development and introduction of arthroscopy made it possible to improve the quality of surgical care for injuries of the shoulder joint. However, despite the minimally invasive technique, the issues of postoperative analgesia in this type of surgical interventions have not been fully developed. The article discusses the possibility of using single and prolonged conductive anesthesia in patients with arthroscopic operations on the shoulder joint.

Physical Simulation Environment for Arthroscopic Joint Irrigation

Good arthroscopic view is important to perform arthroscopic operations (minimally invasive surgery in joints) safely and fast. To obtain this, the joint is irrigated. However, optimal irrigation settings are not described. To study the complex clinical practice of irrigation, a physical simulation environment was developed that incorporates the main characteristics for performing arthroscopy. Its irrigation capacities were validated with patient data. The physical simulation environment consists of a specially designed knee phantom, all normally used arthroscopic equipment, and registration devices for two video streams, pressures, and flows. The physical embodiment of the knee phantom matches that of human knee joints during arthroscopic operations by the presence of important anatomic structures in sizes comparable to human knee joints, the presence of access portals, and the ability to stress the joint. The hydrostatic and hydrodynamic behavior of the knee phantom was validated with pressure and flow measurements documented during arthroscopic knee operations. Surgeons confirmed that the knee phantom imitated human knee joints sufficiently. The hydrostatic parameters of the knee phantom could be tuned within the range of the human knee joints (restriction: 0.0266–29.3 N s2/m8 versus 0.0143–1.22×1018 N s2/m8 and capacitance: 6.89 m5/N versus 7.50×10−9 m5/N). The hydrodynamic properties of the knee phantom were acceptably comparable to those of the human knee joints. The physical simulation environment enables realistic and conditioned experimental studies to optimize joint irrigation. The foundation has been laid for evaluation of other surgical instruments and of training of surgical skills.

The Cost of Shoulder Arthroscopy: A Comparison with National Tariff

INTRODUCTION ‘Payment by results’ was introduced with the aim of providing each trust with a transparent and fair remuneration for the work done. Hospitals are paid a tariff for each Healthcare Resource Group (HRG). The tariff is calculated at a national level, by means of a complex manipulation of historic financial data. However, the financial viability of a hospital relies on these payments and so accuracy is vital. PATIENTS AND METHODS We conducted a cost analysis of shoulder arthroscopic procedures carried out at an elective orthopaedic unit. This unit is self contained and well audited, providing an unique opportunity to make a more accurate cost analysis. We calculated the cost of the facility, consumables/implants, anaesthetics and staff pay. This was then compared with the amount paid to the trust. RESULTS All arthroscopic operations performed at our institution attract a tariff of £1780. Our cost of a subacromial decompression was £1307, a profit of £473. A rotator cuff repair was £2672, a loss of £892. CONCLUSIONS The tariff is inaccurate. The arthroscopic HRG is too general and fails to address the extra time and expense of equipment some procedures utilise. We found cost was very sensitive to length of operation. Delays and even teaching can make a ‘profitable operation’ lose money for the trust.

Arthroscopic Treatment of Metacarpophalangeal Arthropathy in Haemochromatosis

A 37-year-old sports teacher suffering from idiopathic haemochromatosis with arthropathy of the MP joints has been treated and followed-up by us for 4 years. Three out of four affected MP joints were treated with arthroscopic operations; one of these had been treated elsewhere previously by arthrotomy. This article presents a brief review of the condition and its treatment by arthroscopic surgery with detailed technique. We believe that MP joint arthroscopy in certain cases is an alternative to open surgery and gives excellent results. No specific instruments are needed apart from a standard small joint arthroscopy set.