VREDEN RUSSIAN RESEARCH INSTITUTE OF TRAUMATOLOGY AND ORTHOPEDICS

Currently, the use of bone allografts for reconstructive orthopedic surgery in clinical practice around the world is becoming a common procedure. Bone allografts are the first substitute material to the autologous bone and the best alternative to any artificial substituting material. The methods used for the preservation, processing and sterilization of bone are changing and evolving with time. The main goals remain the same including exclusion of infections and creation of the material with sustained properties of the normal bone.The present review reflects the essential methods for biological tissue processing, sterilization and preservation with the analysis of the key requirements for manufacturing of safe allogeneic osteoplastic materials with osteoinductive, osteoconductive and osteogenic properties

EPIDEMIOLOGY OF PRIMARY HIP ARTHROPLASTY: REPORT FROM REGISTER OF VREDEN RUSSIAN RESEARCH INSTITUTE OF TRAUMATOLOGY AND ORTHOPEDICS

The   paper   presents   data   analysis   of  the   Hip   Arthroplasty  Register   of  Vreden   Russian   Research   Institute of Traumatology and Orthopedics, namely information on 37373 primary THA performed at the Vreden Institute and at several other orthopedic centers and 1200 hip replacements at other hospitals of St. Petersburg.There were 1.5 times more women in the studied cohort than men. A significant predominance of women with dysplastic osteoarthritis (72.4%) and rheumatoid arthritis (82.1%) was reported. A male predominance was noted in patients with secondary osteoarthritis (53.1%), post-traumatic changes of hip (61.0%) and osteonecrosis of the femoral head (68.6 %). The mean age of patients was 58.0±12.9 years (95% CI from 57.9 to 58.1, median 59 years). Age data of the study revealed that  patients were 10-12 years younger than reported in the national  arthroplasty registers of other countries.Total  hip arthroplasty was performed  in the  absolute  majority  of patients – 37295  cases (99,8%).  Uncemented implants  were used in 59.3% of cases, hybrid – in 29.6%, cemented – in 10.2%, reverse-hybrid – in 0.9% of all patients. The  most  common  bearing  used  was metal  on  crosslink  polyethylene, which  was applied  in 50.1% of all cases of arthroplasty. The  type  of fixation  of the  implant,  and  the  use of different  bearings  varied  in different  age groups. The paper presents  not only the absolute  numbers  of the data, but also demonstrated the dynamics  of the changes in time starting from 2007.The  present  epidemiological  study  does not  claim the  absolute  completeness of the  presented data,  but  contains the  analysis of the  large number  of cases, comparable  with  follow-ups  of patients in some national  registers  of certain European countries. The authors  analyzed about  10% of all cases of hip replacements performed  on the territory of the Russian Federation in ten-year  period

What Has Changed in the Structure of Revision Hip Arthroplasty?

The key aspects of the study: 1) what has changed in the structure of revisions in recent years? 2) what is the spectrum of reasons for revision after primary hip arthroplasty and re-revision? 3) what are the demographic features of patients’ population undergoing the revision? Materials and methods. The authors conducted a retrospective evaluation of 2415 hip revision cases during the period of time from 2014 until 2018. Separately the authors assessed revisions after primary surgeries and re-revisions as well as the group of early revisions. Results. In the period from 2014 until 2018 the overall share of revisions was 16,6% from all total hip arthroplasties, at the same time the authors reported the absolute 1.7 times increase in number of revisions as well as increased share of revisions in the total structure of hip arthroplasty from 12,5% to 18,9% without significant variances in the number of primary procedures. The share of early revisions increased from 32.9% in 2013 to 56.7% while the number of early revisions amounted to 37.4% of all primary revisions. Gender composition in primary and revision hip arthroplasty varied insignificantly. Mean age at the moment of hip revision was 59.2% (95% CI from 58.7 to 59.7; Me 60 years) which is slightly less than in primary replacement — 60.2 years (95% CI from 58.9 to 61.1; Me 62 years), but such variances had a high statistical significance, р<0.001. The main reasons for primary revisions were aseptic loosening of prosthesis components (50.3%), infection (27.6%), polyethylene wear and osteolysis (9.0%) as well as dislocations (6,2%). Re-revisions structure featured prevalence of infection (69.0%), aseptic loosening (20.8%) and dislocations (7,8%). Mean period of time after primary hip arthroplasty to revision was 7.9 years (95% CI from 7.7 to 8.2; Me 7.3), to first re-revision — 2.9 (95% CI from 2.6 to 3.2; Me 1.2), to second re-revision — 2.2 (95% CI from 1.8 to 2.7; Me 1.1), to third — 2,2 (95% CI from 1.7 to 2.8; Me 1.1), to fourth — 1.0 (95% CI from 0.6 to 1.3; Me 0.6), remaining cases demonstrated rather high heterogeneity. Conclusion. In the result of the present study the authors observed increased number of all revision hip arthroplasties, especially the share of early revisions within first five years from the moment of previous surgery. The most often reason for revision after primary hip arthroplasty was aseptic loosening of one or both components of prosthesis. Infection was the absolute leader in the group of re-revisions constituting over half of all reasons for secondary intervention