Mid-Term Results of Two-stage Revision Total Knee Arthroplasty for Infected Total Knee Arthroplasty

Introduction. Today, knee arthroplasty is one of the most common surgical procedures. Infection after endoprosthetics is the most dangerous complication in patients who have undergone total knee arthroplasty, which negatively affects the prognosis. Most cases of infection develop within the first 2 years after surgery, and the frequency is 1.5%, and after that it decreases to 0.5%. Material and Method. When a study group of 31 patients (22 female, 9 male) who were diagnosed with infected knee prosthesis and underwent two-stage revision knee prosthesis as a treatment method; the mean age of all patients (31 patients) was 68.78 years. In our study by using the American knee association scoring system; preoperative knee scores of 31 patients who underwent two-stage revision surgery were 35.43 ± 7.14, while this parameter was found to be 83.27 ± 8.89 postoperatively (p <0.01). Conclusion. We believe that two-stage revision surgery is an effective method in the treatment of infection that develops after primary total knee arthroplasty application. Restoration of the joint line in accordance with the anatomical structure will positively affect the clinical results, and the use of a long stem to increase the stability of the prosthesis is appropriate for successful results, especially in the cases with bone defects. Key words: Total Knee Arthroplasty, Two-Stage Revision Surgery, Infected Knee Prosthesis.

Impact of the COVID-19 Pandemic on Injury Rates in the World and in Kazakhstan

During the COVID-19 pandemic, there has been an overall decrease in injury rates. The type of injury also changed depending on the period and the strengthening of restrictive measures: the number of street, sports, and school injuries decreased. However, the share of domestic injuries increased. This information can be useful in planning the work of health authorities and allocating resources in pandemic situations that may arise in the future. Keywords: injuries, COVID-19, pandemic, quarantine measures, Kazakhstan.

Ultrasonography of the Anterolateral Ligament of the Knee Joint. The State of the Art and the Perspectives

The anterolateral ligament of the knee is an important stabilizer of the knee in relation to internal rotation of the lower leg. Ultrasonographic examination of the anterolateral ligament of the knee joint is a simple and affordable method for its study, it allows to evaluate the femoral and tibial portions, has prospects for improving and improving the understanding of its function. The indication for its implementation is suspicion or confirmed damage to the anterior cruciate ligament. Ultrasonographic studies of the anterolateral ligament are not only important from the perspective of diagnosing its damage, but have already supplemented our understanding of its structure and function. Key words: ultrasonography, anterolateral ligament, knee joint.

Results of a Study of Bone Mineral Density in Children and Adolescents with Low-energy Fractures of Long Bones

The aim: to determine the initial indicators of bone mineral density in children and adolescents with fractures of long bones, to assess the status of vitamin D. Methods. We studied the data of densitometric and laboratory methods of studying 46 sick children (39 (84.8%) boys and 7 (15.2%) girls) with long bone fractures at the age from 6 to 18 years. Bone mineral density was assessed by the method of dual-energy X-ray absorptiometry on a bone densitometer using the Eurasian regulatory database. Results. In 9 sick children with fractures, osteopenia of the I degree was revealed, in one patient - osteopenia of the II degree, in 5 patients - osteoporosis of the I degree, in the remaining 31 children the indicators of bone mineral density corresponded to normal values. Low calcium levels in 56.4% of boys and 57.1% of girls, along with increased alkaline phosphatase activity in 94.8% of boys and 100% of girls, testified to impaired bone formation. The results showed that 61.5% of boys were deficient and 57.1% of girls were deficient in vitamin D. Conclusion. Low bone mineral density, the presence of hypovitaminosis D in children and adolescents with low-energy fractures, given the importance of these indicators for fracture healing, require correction of the revealed violations: the choice of more gentle treatment methods, the appointment of adequate drug therapy, dynamic monitoring of the effectiveness of the prescribed therapy, and in children with a confirmed diagnosis of osteoporosis - studies of bone mineral density in dynamics. Key words: bone mineral density, low-energy fractures of long bones, hypovitaminosis D, osteoporosis, fractures in children and adolescents, Uzbekistan.

Impregnation of a Bone Marrow Allograft with an Antibiotic Prepared According to the Marburg System, an Original Method

The aim: To develop an original method of antibiotic impregnation of bone allograft prepared according to the Marburg bone bank system. Methods. The work was divided into three parts (as part of an experimental study). The first part of the study included the collection and preparation of bone allograft, which was carried out on the basis of the Hospital named after professor Makazhanov, where the femoral heads were harvested, removed during arthroplasty and heat-treated according to the Marburg system of the bone bank. The second stage of the study was to select the optimal antibacterial drug for impregnation, by determining their thermal stability. The determination of thermal stability was carried out at the Department of Microbiology of the Karaganda Medical University. The third stage of the study included conducting experimental work on the development of an impregnation method and evaluating the antibacterial effectiveness of impregnated bone allografts. Results. Heat-treated bone allograft, perforated by the original method using a developed perforation device (the latter received a patent), and then soaked in an antibiotic, showed suppression of the bacterial growth zone by more than 2.5 times (p=0.01), in comparison with other groups. Conclusion. The proposed bone allograft is biodegradable and is close to autologous bone in its physical and mechanical properties. The optimal method of impregnation is bone allograft perforation, developed by an original method using a special perforation device. Keywords: bone allograft, Marburg system, bone bank, antibiotics, osteomyelitis, impregnation, osteo-replacement material.

The Dynamics of Indicators of Industrial Injuries in Karaganda Region

The aim of the study. To conduct a comparative analysis of the indicators of industrial injuries in Karaganda region for 2015-2019. Methods. The article analyzes the data on industrial injuries in Karaganda region for 2015-2019 years by the method of descriptive statistics, as well as the material consequences of accidents. Results. In Karaganda region, the number of victims in accidents related to labor activity per 100 thousand adult populations is 2.5 times, and the number of deaths is 2.2 times higher than the national indicator. Over the 5-year period, there has been a slight decrease in the number of work-related fatalities from 9.9% in 2015 to 9% for 2019. At the same time, there was a 1.2-fold increase in material costs. Conclusions. In Karaganda region for 2015-2019, the number of people injured at work decreased. Nevertheless, the level of industrial injuries remains quite high, indicating the need to improve the procedure of certification of production facilities on working conditions, as well as the regulatory framework on compliance with working conditions in the mining industry. Keywords: occupational injury rate, fatality rate, disability rate, Karaganda region, Kazakhstan

The role of the National Scientific Center of Traumatology and Orthopedics named after academician Batpenov N.D. in the formation and development of traumatology - orthopedic service of the Republic of Kazakhstan

The 20-year period of work of the National Center for Traumatology and Orthopedics named after academician Batpenov N.D., determined its role as an advanced center for the training of highly qualified scientific and pedagogical personnel, for the development and implementation of innovative diagnostic and treatment technologies in the field of traumatology and orthopedics. The material presents the results of the analysis of the center's activities, including its contribution to the development of the national traumatology and orthopedic service, as well as the scientific and pedagogical contribution. Keywords: organization of traumatological and orthopaedic care, traumatism, scientific activity, high-tech medical care, Kazakhsta

Experience in Organizing the Activities of an Infectious Hospital Established on the Basis of a Specialized Scientific Center During the COVID-19 Pandemic (on the example of the National Scientific Center of Traumatology and Orthopаedics named after Academician Batpenov N.D.)

Purpose of the message to study the results of the first experiment on the re-profiling of a specialized scientific center in order to organize an infectious hospital for the treatment of patients with COVID-19. Methods. The article analyzes the results of the activity of an infectious hospital organized on the basis of the National Scientific Center of Traumatology and Orthopаedics named after Academician Batpenov N.D. during the COVID-19 pandemic. The analysis includes the activities carried out within the framework of the re-profiling of the hospital, as well as statistical data on patients treated and medical services provided for the period from March 26 to August 26, 2021. Results. The infectious diseases hospital has been receiving patients for more than 5 months, during this time more than 1300 patients with COVID-19 have been treated. The correct and concrete actions of the management of the Center and the city health department made it possible to organize the clinic's activities in an emergency situation in such a way that the work on the main profile was not affected. Conclusion. The lessons learned have long-term consequences for the entire public health of the city and the republic. The accumulated experience in the work of the newly created infectious hospital for the treatment of patients with CОVID-19 can be used in the further medical activities of medical organizations of military and civilian healthcare. Keywords: COVID-19 pandemic, infectious diseases hospital, hospital conversion.

Issues of Medical Products Import Phase-out Applied in the Field of Traumatology and Orthopaedics of the Republic of Kazakhstan. Policy Brief

What the problem is? - Medical products applied in the field of traumatology and orthopaedics of Kazakhstan are fully import phase-out; - Measures carried out within the framework of medical products import phase-out applied in this field have been put on hold due to lack of funding. Policy options • Option 1. Regulatory and economic support from the state in particular an assistance in investors attracting for production growth of the domestic medical products applied in the field of traumatology and orthopaedics; • Option 2. Upgrade training of participants of the process on medical products import phase-out applied in the field of traumatology and orthopaedics of Kazakhstan for promotion of competitiveness on the market; • Option 3. Development of longstanding complex research and practice program for formation of clinical evidential base on efficiency and safety of medical products the manufacturing of which is planned within the framework of import phase-out policy. Policy options realization perspective Our three policy options are mutually supportive. The combined realization of these policy options will allow organizing the production of domestic medical products in the field of traumatology and orthopaedics with the aim of import phase-out. Conclusions Import phase-out of medical products in the field of traumatology and orthopaedics (prostheses, implants, various plates, etc.), of course, is an effective solution in terms of economics. However, to achieve this goal from the state, regulatory and economic support is needed. In turn, the manufacturer must also increase its own potential. We expect that after the stabilization of domestic production of medical products in traumatology orthopaedics and full-fledged import phase-out, problems associated with the export of these products may arise. We believe that a “vertical” strategy focused on the domestic market is most suitable for the development of domestic production of medical products. Key words: traumatology and orthopaedics, medical products, import phase-out, Kazakhstan

Surgical Treatment of Combined Instability of the Knee Joint Caused by Damage to Three Stabilizing Ligaments (ACl, PCL, MCL). Clinical case

This article presents a clinical case of combined injury of three ligaments (anterior and posterior cruciate and medial lateral ligaments) in a 46-year-old overweight woman (BMI = 38). The late diagnosed damage to the ligaments and the lack of conditions for their normal recovery led to combined instability of the knee joint and the appearance of indications for their reconstruction. At the moment, 6 weeks after the operation, the patient began to step independently on the operated limb, the range of permissible movements in the knee joint was flexion up to 90 degrees. The planned period of full recovery is 24 weeks. Key words: combined knee joint instability, posterior cruciate ligament, medial lateral ligament, anterior cruciate ligament, knee injury, clinical case.