Evaluation of the effectiveness of the use of low-traumatic surgical access in the reverse shoulder arthroplasty

BACKGROUND: The number of reversible shoulder joint endoprostheses installed in the world at the present stage is several times greater than the number of hemiarthroplasty performed. Nevertheless shoulder arthroplasty is considered a traumatic operation and can be accompanied by a number of complications, both from the side of implants and due to the traumatic nature of the surgical technique. During surgical interventions on the shoulder joint with a wide dissection of the skin and subcutaneous tissue, iatrogenic damage to structures such as the axillary nerve, posterior and anterior arteries and veins surrounding the humerus can often be detected, which triggers a whole cascade of pathophysiological and regulatory processes in which Interventions immediately release inflammatory mediators. Therefore, orthopedic traumatologists strive to reduce the risk of intra- and postoperative complications, and it is necessary to improve the surgical technique of surgical interventions towards their less traumatic performance. AIM: Development and evaluation of the effectiveness of the use of low-traumatic surgical access when performing reverse shoulder arthroplasty. MATERIALS AND METHODS: In the period 20172020, 169 patients with various diseases, injuries of the shoulder joint and their consequences were operated on in the Department of Adult Orthopedics of the N.N. Priorov National Research Medical Center of the Russian Federation, who underwent reverse shoulder arthroplasty according to generally accepted indications. In the main group (84 patients), surgical treatment was performed using a low-traumatic surgical approach, while the control group (85 patients) underwent standard procedures. Functional, clinical and radiological results of surgical treatment of patients of the main and control groups were evaluated and compared after 3, 6 and 12 months. RESULTS: In the main group, excellent results (25 points on DASH) were observed in 73 patients, good results (2650 points) in 10 patients. In 1 patient, the results were assessed as satisfactory (5175 points). In the control group of observation, the clinical result was worse (68 excellent, 16 good and 1 satisfactory result). CONCLUSION: On the basis of the performed study, taking into account the better results in the main group of patients, the technique of low-traumatic surgical access for reverse shoulder arthroplasty can be recommended for wide use in clinical practice.

Impact of isometric exercising as to development of physical characteristics typical of dorsopathy patients at incomplete remission stage

BACKGROUND: The positive impact of isometric exercising, which makes muscle strength indicators grow, has been known for a long time. However, very few studies have been devoted so far to the examination and assessment of the effect in terms of their application for practical healthcare purposes. AIM: It is aimed to assess how a therapeutic isometric exercising impacts the dynamics of basic physical conditions of abdominal and back muscle groups as well as the decrease in pain syndrome severity, which Lumbar spine dorsopathy patients have during an incomplete remission state after the treatment is over and in a remote period (in six-month period). MATERIALS AND METHODS: The retrospective analysis of data based on clinical and functional examination methods and treatment results was conducted involving 72 patients aged 2550 years old with the confirmed dorsopahy diagnosis. The data were acquired with the use of FSSD profile and tension dynamometry Back-Check Dr. Wolff (Physiomed Elektromedizin AG, Germany). The visual analogue scale (VAS) was applied to determine the pain syndrome intensity. RESULTS: Further analysis of the acquired results showed the increased rate of the BPC indicators of strength (p 0.05) and endurance to static and dynamic loads produced with the key posture-dependent muscle groups (p 0.05) as well as decreased intensity of the pain syndrome the dorsopathy patients had (p 0.05). CONCLUSION: Isometric exercising helps to lower the pain syndrome intensity assessed as per the VAS (p 0.05), increase the muscle strength and the core endurance towards static and dynamic loads.

Diagnosis and treatment of congenital vertical talus in children under 3 years old (review)

Congenital vertical ram is a rare pathology, the incidence of it is 1 case per 10 thousand newborns. This anomaly is usually manifested by a severe planovalgus deformity of the foot. Moreover, it is often (in 50% of cases) associated with chromosomal syndromes (arthrogryposis, neurofibromatosis, myelodysplasia, etc.), with spinal, neuromuscular anomalies of development. As a result, it is necessary to focus the attention of pediatric orthopedists and radiologists on the parameters of the diagnosis in order to reduce false diagnoses and unreasonable surgical interventions in children, show options for surgical techniques for the treatment of feet with an inborn vertical position of the talus in children under 3 years. The presented review of domestic and foreign literature demonstrates the main advantages and disadvantages of existing approaches in the treatment of children under 3 years of age with congenital vertical ram. Demonstrate the main advantages and disadvantages of existing approaches in the treatment of this pathology. Analysis of the literature showed that the causes of the formation of the congenital vertical talus are not fully explored. In Russia, up to the present moment, its diagnosis is still difficult. Congenital vertical talus is one of the rare problems in world orthopedic practice in comparison with congenital clubfoot, but doctors who are constantly treating children with deformities of the feet have such patients regularly.

Features of rehabilitation of patients with rheumatoid arthritis after arthroplasty (review)

Rheumatoid arthritis is a social problem due to high disability, reaching 90% among the population. A detailed disclosure of the social significance of nosology shows that in the first 5 years of the disease, about half of the patients get a disability, in the first 10 years 2/3 of the patients. The destruction of large joints is the result of a long course of the disease. Many studies say that after 10 years from the onset of the disease, a third of patients need arthroplasty of the large joints of the lower extremities. Polyarthritic joint damage leads to the difficulty of carrying out restorative treatment. The article the main methods of rehabilitation of patients after arthroplasty of the joints of the lower extremities, assessed the effectiveness of each method in the treatment of patients with osteoarthritis of large joints, and proposed their own version of therapeutic physical activity in water. The advantage of this method is to reduce pressure on other joints and to concentrate force on the operated limb. In addition, some authors talk about the analgesic effect of thermotherapy, ultrasound therapy and balneotherapy. Thus, the postoperative treatment of patients with rheumatoid arthritis is an important part of the overall treatment and enhances the effectiveness of surgical correction. The most important and accessible physiotherapy procedures are kinesiotherapy and aqua gymnastics. According to the results of the article, other methods only complement the main therapeutic effect.

In memory of Professor Valentin N. Guryev

At the 99th year of his life, Valentin Nikolayevich Guryev, Honored Scientist, Laureate of the State Prize of the USSR, Doctor of Medical Sciences, Professor, Veteran of the Great Patriotic War, was gone. He made an enormous contribution to the organization and scientific development of medical care by a team of specialists at the prehospital stage, which made it possible to reduce mortality in patients with multiple and concomitant injuries by one third. The collective of the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics grieves over the loss, the bright memory of a talented surgeon, scientist, organizer, cheerful and charming person will forever remain in the hearts of friends, colleagues and students.

Electrophysiological patterns of sciatic nerve in patients with arthrosis deformans of the hip

BACKGROUND: Neurological complications in sciatic nerve (SN) after a total hip replacement (THR) are observed in 0.93.2% of cases in patients with arthrosis deformans and age-related morphologic changes in SN. These cause the need for SN evaluation before THR. This research was aimed at the evaluation of the initial SN capacity with electrophysiological findings in patients with arthrosis deformans of the hip. MATERIALS AND METHODS: Electroneuromyography (ENMG) was used to evaluate fibular and tibial nerves M-responses as well as F-waves in 66 patients with dysplastic coxarthrosis and 12 patients with posttraumatic coxarthrosis. The findings were compared to those of the controls. RESULTS: Changes in ENMG findings for fibular nerve in 49 patients with dysplastic coxarthrosis were bilateral and showed significant difference only from the norm. In 19 of 66 cases (27.9%) low M-responses (р 0.02) were found in the side subject to THR. In 87.3% of cases, the signs of a decrease in the conductivity of proximal segments of the tibial nerve were revealed. In patients with posttraumatic coxarthrosis, the significant decrease in ENMG findings from both fibular and tibial nerves was observed in the affected side, they made up just 42-50% of those in the opposite side. Asymptomatic progress of denervation damage in hip and tibia muscles sometimes required needle EMG to fund the signs of motor innervation disorder. A-waves revealed in 65% of patients suggested local damage to one or both portions of SN. CONCLUSION: ENMG findings in patients with dysplastic arthrosis of the hip enabled revealing of the signs of neuropathy before surgeries and decreasing the risk of neurologic post-surgery complications.

Two-year results of clinical use of arthromedullary bypass for knee osteoarthritis

BACKGROUND: With the ineffectiveness of conservative therapy for the knee joints osteoarthritis (OA), arthroscopic debridement (AD) of the affected joints is a common method of surgical treatment. However, the results of studies indicate a low efficiency of the use of AD in gonarthrosis. In order to improve the results of the use of AD in the knee joints OA, it was proposed to use an original implant to communicate the bone marrow cavity and the cavity of the knee joint. In the immediate postoperative period, such arthromedullary bypass surgery revealed a rapid improvement in the condition of the affected joints, a decrease in the severity of symptoms, and a decrease in the need for pain relievers. AIM: To compare the results of arthroscopic surgery in patients with knee osteoarthritis without and with the use of arthromedullary bypass (AMB) of joint at 2 years after the intervention. MATERIALS AND METHODS: The results of a comparative study involving 147 patients aged 42 to 80 years with knee osteoarthritis were presented. In the control group (67 patients), only arthroscopic debridement was performed; in the study group (80 patients, 90 operations) AMB was additionally performed (10 patients on both knee joints) for the entry of an intraosseous content into the joint cavity. The results were evaluated 3, 6, 12, and 24 months after surgery, using the Lequesne algofunctional index and the WOMAC index and the need for the nonsteroidal antiinflammatory drugs (NSAID) was assessed. RESULTS: The positive dynamics of both indicators in both groups during the first 3 months of follow-up was maintained for 24 months, and their more significant changes, as well as a decrease in stiffness and the frequency of nocturnal joint pain, occurred in the study group (p 0.01). 24 months after surgery, 87% of patients in the study group refused to take regular NSAID, and 54% in the control group (p 0.01). During the AMB, the percentage of operations with unsatisfactory and moderate results decreased by 2.53.5 times, and the percentage of cases with good and excellent results was 28% higher compared to the control group (p 0.01). СONCLUSIONS: The proposed AMB of joints had a long-term beneficial effect and is promising for the treatment of patients with knee osteoarthritis who do not respond to conservative treatment. Its use can improve joint function, reduce joint pain and dependence on analgesics, and thus ease the severity of the disease in more patients.

Repositional-fixation ring for surgical treatment of acetabular fractures (preliminary results of static tests)

BACKGROUND: Currently, several types of designs of support rings of M. Muller, Burch-Schneider, rings of the company Protek (Switzerland), implanted in the BB are widely used, which are used in the surgical treatment of long-standing fractures of the BB, as a rule, as a device that strengthens the walls of the BB. AIM: Study of the deformation properties of the repositional-fixing ring. MATERIALS AND METHODS: For carrying out mechanical tests, a ring with an external diameter of 52 mm was made by the method of sequential sintering using additive technologies by the company Konmet LLC, Moscow. Laboratory mechanical tests were carried out by the Testing Laboratory of Medical Devices and Materials of the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics. RESULTS: As a result of static testing of the ring for compression, tension, torsion, and joint stretching and twisting of the edges of the ring connector, its deformation properties are studied. Load corresponding to the deformation of 2 mm, kN: compression 0.180; tension 0.061; torsion (torque corresponding to the angle of rotation of 5 degrees, Nm) 2.653; joint tension with twisting of the edges of the ring connector (load corresponding to the deformation of 10 mm, kN) 0.048. CONCLUSION: The results of the initial study of the deformation behavior of the ring structure show that it is necessary to refine the ring design and further study the deformation and strength characteristics of the ring.

The history of the development of elbow arthroplasty

Total elbow arthroplasty is a good alternative surgical solution for many patients with severe traumatic and inflammatory joint injuries. In case of bones multiple fractures of the elbow joint, arthroplasty can restore the stability of the joint and provide early mobilization of the limb, which is not always possible when performing osteosynthesis. This literature review provides information on the design features of foreign and domestic endoprostheses of the elbow joint, long-term results of operations. The turbulent history of the development of elbow arthroplasty goes back over 60 years. At the same time, due to insufficient understanding of the biomechanics of the joint, the first attempts at its arthroplasty failed. Only in the early 70s, in connection with the improvement of the endoprostheses design and the operation technique, publications on the successful results of total elbow arthroplasty appear in the literature. In the 80s of the XX century implants with a semi-connected design and cemented placement technique have been developed, which still demonstrate better long-term results in comparison with implants with anatomical design. The analysis of publications on the topic of total elbow arthroplasty showed that significant achievements were observed only in the early 1990s, which is largely due to a better understanding of the biomechanics of the elbow joint, as a result, to the improvement of implant design and surgical technique.

Reverse shoulder arthroplasty in cases of glenoid defects using primary-revision metaglene

BACKGROUND: Reverse shoulder arthroplasty is one of the surgical treatment methods of the shoulder joint injuries and diseases accompanied by pronounced changes in the anatomy of the articular structures. Considering the positive aspects of reverse shoulder arthroplasty, the indications for this operation are expanding over time. However, during this operation, errors are possible that lead to early dislocation of the endoprosthesis, compression of the metaglene to the scapula, screw instability and migration of the scapular component. Given the lack of a generally recognized clear algorithm of actions in these complex cases, the problem of reversible shoulder arthroplasty in case of defects in the articular surface of the scapula are relevant. AIM: To develop and evaluate the effectiveness of the method of compensating for the lack of bone tissue of the scapula in the reverse shoulder arthroplasty MATERIALS AND METHODS: In the Department of Adult Orthopaedics of the N.N. Priorov National Research Medical Center, reverse shoulder arthroplasty was performed in patients with scapular bone mass deficiency, who needed to fill in both marginal defects for the installation of metaglene with the correct angle of inclination, and the replacement of extensive defects with the necessary level of glenosphere lateralization. RESULTS: Follow-up of patients who underwent glenoid remodeling using bone autoplasty and subsequent shoulder reverse artroplasty within a period of 6 to 24 months. Remodeling and osseointegration of the grafts were determined, without signs of metaglene instability by the end of the 3rd month after the operation. The complex of rehabilitation measures and the time of recovery of movements in the operated joint did not differ from those of conventional reverse arthroplasty. CONCLUSION: Given the high efficiency of the proposed algorithm, the method used to compensate for the lack of bone tissue of the scapula in shoulder reverse arthroplasty can be recommended for implementation in a wide clinical practice.