93 research outputs found
ORIGINAL METHOD OF FEMORAL NECK OSTEOSYNTHESIS WITH NON-FREE AUTOPLASTY
Applied topographic-anatomical studies were carried out on 12 fixed lower extremities and revealed that in the anterior portion of the middle gluteus muscle 4 cm in width the upper branches of the gluteal vessels are always held supplying the area of the iliac crest. Taking into account the received data the authors proposed a new method of femoral neck osteosynthesis with non-free autoplasty by the autograft from the iliac crest, which is moved at constant muscle-vascular supply pin and fixed with screw in the fracture. Osteosynthesis using the proposed method was performed in 24 patients and provided the union of fractures in all cases in a period of 5 to 8 months. Analysis of long-term results of treatment of 22 patients performed 3 years after the operations showed good function of injured joints and no evidence of avascular necrosis of the femoral head in 18 (83.3%) cases
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
THE STRUCTURE OF EARLY REVISIONS AFTER HIP REPLACEMENT
The authors retrospectively reviewed RNIITO Arthroplasty Registry data of revision total hip arthroplasties performed in RNIITO in 3 year period (2011-2013). Part of early revisions within 5 years after the index procedure in general revision structure was 33% . Two hundred seventy three (64%) procedures had infection reason, 79 (19%) - aseptic loosening, 35 (8%) - dislocation and 27 (6%) - periprosthetic fractures in reasons of revision, respectively. More than half of revisions were performed within the first year after the index procedure. Early primary revisions after index total hip arthroplasty were performed in 254 (59,8%)cases, and repeated revisions were performed in 171cases one or more times. Of early primary revisions 125(49,2%) patients had index total hip athroplasty in our hospital, and 129 (50,8%) patients had index total hip athroplasty in other hospitals of Russian Federation. Our THA early revision structure is differs significantly from published in literature, moreover there is difference between revision reasons after primary total hip arthroplasty of our hospital and other hospitals. Revision reasons structure doesn’t show rate of primary THA complications, but defines main problems that should be solved
EVALUATION OF DEBRIDEMENT EFFECTIVENESS FOR THE TREATMENT OF PERIPROSTHETIC JOINT INFECTIONS OF THE HIP
Purpose - evaluation of the effectiveness of debridement in the treatment of periprosthetic infection and detection of possible factors affecting the outcome. Material and methods: Analysis of the effectiveness of treatment in 125 patients with periprosthetic infection operated at Vreden Russian Research Institute of Traumatology and Orthopedics in 2008-2012 was carried out. All patients underwent endoprosthesis-saving sanitation surgery at different times. The effectiveness of surgery was evaluated using clinical, X-ray, laboratory, and statistical methods. To estimate a subjective component, Harris and visual analog scales were used. Results: Recurrent infections after sanitation surgery were detected in 20 (15.7%) patients (Group 1). 105 (84%) patients in the follow-up of above 12 months demonstrated remission of infectious process (Group 2). Cardiovascular pathology and obesity were significantly more common in Group 1 patients (
Unexplained pain after total knee arthroplasty
Although total knee arthroplasty (TKA) improves function and reduces pain for the large majority of the patients, a few continue to have pain and require investigation. The causes of dysfunction and pain after total knee arthroplasty can be described as intrinsic (intra-articular) or extrinsic (extra-articular) sources of pain. For the majority of the cases, following a complete evaluation protocol, the cause of pain can be identified and a specific treatment can be applied, however occasionally there remains a group of patients with unexplained pain whose management is difficult. It was our hypothesis that revising a TKA without pre-operative diagnosis of the failure is not worth. Therefore, the aimed of this review was to: 1) analyse the results of revision TKA for unexplained pain, and 2) described the potential solutions for an alternative conservative management of the painful TKA
Results of hip arthroplasty using Paavilainen technique in patients with congenitally dislocated hip
The purpose of the study was to analyze the medium- and long-term results of hip arthroplasty using Paavilainen technique in patients with the congenitally dislocated hip. Methods: From 2001 to 2012 180 operations were carried out were using the Paavilainen technique in 140 patients with high dislocation of the hip (Crowe IV). All patients were clinically evaluated using the Harris Hip Score (HHS), VAS and radiography. Statistical analysis was performed using the Pearson correlation coefficients, multiple regression analysis and classification trees analysis. Results: The average Harris score improved from preoperative 41.6 (40,3-43,5) to 79.3 (77,9-82,7) at final follow-up, and the difference was significant. Early complications were 9% (the most frequent were fractures of the proximal femur), later - 16.7% (pseudoarthrosis of the greater trochanter, 13.9%; disclocations-1,1%, aseptic loosening of the components - 1.7%), reoperation performed in 8.3% of cases. Such factors as age and limb length has statistically significant effect on functional outcomes. Established predictive model allows to get the best possible functional outcome in such patients with severe dysplasia. Conclusions: Total Hip arthroplasty using the Paavilainen technique is an effective method of surgical treatment in patients with the congenitally dislocated hip, but it is technically difficult operation with a high incidence of complications in comparison with standard primary total hip replacement
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
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