Efficiency of two-stage revision arthroplasty in management of periprosthetic knee and hip joint infection

This technique involves removal of implant components, debridement of the purulent focus and installation of a cement spacer which is subsequently replaced with a permanent implant after 3–9 months. Purpose To evaluate mid-term results of two-stage surgical treatment of patients with chronic periprosthetic infection of the knee and hip joints. Materials and methods Treatment outcomes of 172 patients with periprosthetic infection who underwent two-stage revision arthroplasty in the period from 2011 to 2015 were assessed. Among them, 113 patients developed infection after hip replacement and 59 patients had infected knee joint. The average follow-up period was 4 ± 1.58 years (range: 2 to 6 years). Results Out of 113 two-stage procedures of hip joint revision, 102 (90.2 %) cases showed an arrest of infection. Four (3.6 %) patients with recurrence of the purulent process underwent resection arthroplasty, another four (3.6 %) rejected to replace the spacer with an implant, and three (2.6 %) had a two-stage re-revision. Out of 60 (59 patients) procedures of a two-stage knee joint revision, infection was arrested in 50 (83.3 %) cases; eight (13.4 %) had recurrence and underwent knee arthrodesis. One (1.6 %) refused to replace a spacer for an implant, and one more (1.6 %) had a two-stage repeated revision. Conclusions Two-stage knee and hip revision arthroplasty using a cement spacer is an effective option for treatment of chronic periprosthetic infection. It provides infection control in 86.7 % (83.3 % for knee and 90.2 % for hip joints) of cases in the mid-term follow-up period up to 5 years. However, the rate of re-infection remains significant and reaches 13.3 % (9.8 % for hip and 16.7 % for knee joints)

Yaroslavl Aviation Cadets in Enemy Captivity (1942–1945)

The article is devoted to the analysis of the German and Romanian captivity of the cadets of the Yaroslavl Military Aviation School of Fast Bombardiers. There is no special research devoted to this group of prisoners of war in Russian and foreign historiography. The author has determined the time, place, and circumstances of taking the cadets captive; counted their number; found out the location of the camps where they were held. Based on sources of personal origin, the author has established survival strategies in difficult conditions of captivity, forms of resistance, the fate of cadets after their release as well as the names and dates of death of some cadets who died in captivity. The author concludes that Yaroslavl cadets differed from the vast majority of Soviet prisoners of war in their level of education and intelligence, unconditional adherence to communist ideology, good physical fitness, and a sense of camaraderie. They were captured as a result of the defeats of the Red Army in the battles of May–July 1942 at the Crimean and Southern fronts. Like other Soviet prisoners of war, Yaroslavl cadets became victims of the Nazi genocide. Some of them died during the first months in captivity of starvation and diseases caused by it, targeted executions, and suicides. Some improvements in nutrition and accommodation of Soviet prisoners of war, made by the Nazis in order to maximize the use of their labor, increased the cadets’ chances for survival. They spent more than two years in Romanian captivity, and almost three years in German captivity. Maintaining friendly relations with former co-servicemen and other prisoners of war turned out to be a successful survival strategy for the captured Yaroslavl cadets. Along with this, they resorted to concealing their military rank and the presence of a special military education from the enemy. The main forms of anti-fascist resistance of cadets were sabotage at workplaces, escapes, and the continuation of armed struggle with the enemy in Soviet and foreign partisan detachments. Like other Soviet prisoners of war, they were subjected to checks by Soviet security agencies after their release and then tried to prove their loyalty to the Motherland on the war fronts. Nevertheless, for decades, the fact of having been held captive created obstacles to continuing education, career growth, and normal life

Analysis of the economic and clinical effectiveness of one- and two-stage revisions in the treatment of periprosthetic infection of the hip joint (literature review)

Introduction Infection is a devastating complication of joint replacement surgery and is associated with significant medical costs of treatment and rehabilitation. This review is based on the analysis of modern domestic and foreign literature and demonstrates the problem of periprosthetic joint infection (PJI) in terms of etiology, pathogenesis, diagnosis and surgical treatment options for PJI, as well as economic costs in different countries. Currently, two-stage revision arthroplasty is the most used treatment method in the world. At the same time, the number of publications on the effectiveness of one-stage revision arthroplasty in PJI has been increasing every year. Purpose Analysis of the clinical and economic efficiency of one- and two-stage revision arthroplasty interventions for suppression of the purulent inflammatory process and their medical costs Materials and methods The literature search was carried out in open electronic databases of scientific literature PubMed, eLIBRARY and Scopus. The search depth was 22 years. Sixteen articles were selected for economic analysis in which the expenditures on PJI management in developed and developing countries were reported. Also, there were 15 studies on evaluating the effectiveness of two-stage revisions and 26 articles on evaluating the effectiveness of one-stage revisions and 15 articles on analyzing the functional state of the affected limb according to the Harris Hip Score. The following inclusion criteria were used: systematic reviews, literature reviews, cohort studies on the topic of periprosthetic infection. Results The rate of PJI arrest with one-stage method was 89.5 % (Me-88.6; Q1-86 Q3-94) and the average mortality was 2.23 ± 2.24 (Me-1.2 Q1-0.8 Q3 -2.7). The rate of PJI suppression by two-stage method averaged 91.4 % (Me-93;Q1-88.2 Q3-96) with an average mortality rate of 3.2 %. The functional HHS after onestage replacement averaged 81.8 points, and after two-stage revision arthroplasty it was 77.4 points. The economic cost of treating one patient with PJI, according to various authors, varies from 6,500 to 150,000 dollars. Conclusions One-stage revision is cost-effective, has better functional parameters and lower mortality with comparable results in PJI arrest if strict adherence to indications is followed