Complex diagnostics and treatment potential of deep implant- associated infection of knee joint

The review of open access literature on the issues of complex diagnostics and treatment potential of implant-associated infection of the knee joint area was given in the article. We describe clinical signs, the potential of laboratory diagnostics of deep implant-associated infection from the point of view of sensitivity and specificity as well as main methods of surgical treatment of the pathology.</p

Historical dynamics of social and role interaction between a doctor and a patient

The article presents social and role peculiarities of professional interaction in the system "doctor— patient" in the retrospective, various factors influencing the downfall in the social significance of doctor role at the present stage of medicine development from the point of view of a number of theoretical approaches. On the basis of literature review we outlined the necessity of medical sociological investigation for the study of professional practices in medical institutions with various social and role structure and indicated the importance of the development of medical and sociological tools for the assessment of interaction efficiency stipulated by the impact of social and role factor. was performed in the following databases: Web of Science, CyberLeninka, PubMed.</p

Long-term results of posterior anchorage of subaxial vertebra in acute unstable trauma

Aim: to study long-term results of posterior anchorage of subaxial vertebra in acute trauma. Material and Methods. We conducted an analysis of long-term results of posterior anchorage of subaxial vertebra in 17 patients with acute unstable trauma which had undergone complex clinical neurological and instrumental investigation, surgical treatment performed from dorsal approach, and the estimation of long-term results in preoperative period. Results. The obtained data indicate the method of transarticular anchorage to be effective and safe and not to have any negative effect on biomechanical properties of cervical spine in the long-term postoperative period. Conclusion. The use of posterior anchorage in acute unstable trauma is most reasonable in subaxial injuries accompagnied by the deformities of medial and posterior spinal columns.</p

The role of skeletal tissue remodeling markers in the patho-genesis of implant-associated inflammation after primary knee arthroplasty

Aim: to reveal certain mechanisms of the pathogenesis of implant-associated inflammation by the level of resorption and bone tissue genesis markers in patients who underwent primary knee arthroplasty. Material and Methods. Main group consisted of 40 patients with implant-associated inflammation; first comparison group — of 20 patients with primary aseptic loosening of knee joint implant components; second comparison group — of 20 patients who underwent primary knee arthroplasty without complications in post-operative period; control group — of 20 conventionally healthy individuals. The levels of soluble receptor activator of nuclear factor kappa-B ligand and bone morphogenetic protein-2were defined in blood serum of all subjects by ELISA. Results. In patients of main group we observed more pronounced increase of soluble receptor activator of nuclear factor kappa-B ligand content and significant decrease of bone morphogenetic protein-2 content in blood serum; patients of first comparison group demonstrated activation of soluble receptor activator of nuclear factor kappa-B ligand and decreased levels of bone morphogenetic protein-2 in blood serum; patients of second comparison group did not demonstrate any changes in the studied indexes. Conclusion. The activation of soluble receptor activator of nuclear factor kappa-B ligand and decreased activity of bone morphogenetic protein-2 have leading role in the pathogenesis of implant-associated inflammation.</p

Metabolic shifts in subjects with potential risk of primary osteoarthritis

The Aim of the study was to estimate metabolic disorders in subjects with potential risk of primary knee osteoarthri-tis development. Material and Methods. The study included 27 patients: 10 men (37%), 17 women (63%) aged from 33 to 68 years, and 20 healthy people (8 men and 12 women). Traditional biochemical indexes characterizing certain metabolic aspects (total protein, urea, cholesterol, glucose, uric acid, amylase and bilirubin) were studied alongside with the assessment of articular cartilage state by the level of COMP (cartilage oligometric matrix protein), malondial-dehyde and ceruloplasmin. Results. In the course of our investigation we observed elevated COMP (Me=871,4 (792,2; 912,5)), malondialdehyde (Me=5,1 (4,7; 5,5)) and ceruloplasmin (Me=48,4 (41,2; 55,4)) levels. Conclusion. Negative metabolic shifts in the form of cartilage tissue metabolic disorders, activated lipid peroxidation and relative failure of body antioxidant system were observed in patients with potentially high risk of knee osteoarthritis without clinical manifestations of the disease.</p

The role of microbial associations in the development of implant-associated infection after primary total knee replacement

Aim: to study the role of microbial associations in the etiology of implant-associated infection, the peculiarities of associates antibiotic resistance, to propose informative methods for the microbiological diagnostics of mixed infections. Material and Methods. The biological samples from 488 patients with infectious complications after total knee replacement were studied. Microorganisms were isolated and identified using a BD BBL™ Crystal™ AutoReader analyzer and Crystal™ Enteric/ Nonfermenter ID Kit, Crystal™Gram-Positive ID Kit panels. Results. Polyetiological infectious complications comprise up to 21.4-24.8% out of the total number of implant-associated infection cases; microbial associations have broad microbial spectrum and various component structure. Specific gravity of clinically significant microorganisms — methicillin-resistant Staphylococcus aureus, polyresistant enterobacteria and nonfermentative Gram- negative bacteria is statistically higher (p&lt;0.05) among the associates (38.2, 25.2, 64.3 and 72.8% respectively) than in monocultures (18.2, 11.8, 47.5 and 58.3% respectively). Microbiological methods should be modified in order to verify polyetiological implant-associated infection. Conclusion. The organization of microbiological monitoring of polyetiologi-cal implant-associated infections with detailed study of microbial associations structure, the monitoring of associates antibiotic resistance is necessary to optimize the diagnostics and causal treatment of this pathology.</p

The tactics of surgical treatment in metastatic lesions of upper cervical spine.

We demonstrated a successful case of surgical treatment of the patient with metastatic lesion of upper cervical spine with respect to multidisciplinary approach. We performed simultaneous two-stage surgical intervention, the first stage being occipitospondylodesis by multi-segment construction; and second —tumor resection from expanded combined access. It has been stated that the proposed surgical tactics allows performing curative resection in one surgical session without neurological deficit buildup in the postoperative period.</p

The etiological role of opportunistic microflora in the pathogenesis of implant-associated inflammation in patients after primary total knee replacement

The aim: to study etiological role of opportunistic microflora in the pathogenesis of implant-associated inflammation in patients after primary knee joint replacement and antibiotic sensitivity of main agent groups. Material and Methods. The retrospective analysis of microbiological samples of 383 patients with implant-associated inflammation occurred after primary total knee replacement. Results. Gram-positive cocci (63.5%) are the leading agents of implant-associ- ated inflammation, and there is an increase in the etiological role of coagulase-positive Staphylococci. Main agents of Gram-negative group were Enterobacteraceae and non-enzyme bacteria. We revealed high resistance of Staphylo-coccus spp. to antibiotics of various groups. Oxazolidinones and glycylcyclines were the most active among all antibiotic groups. Gram-negative bacteria were highly resistant to cephalosporine and macrolides with carbapenems and fluoroquinolones being most active. Conclusion. Gram-negative Enterobacteraceae, non-enzyme bacteria and Gram-positive cocci are most significant etiological factors in the pathogenesis of implant-associated inflammation in patients after primary total knee replacement.</p

Comparative analysis of clinical outcomes of various methods of anterior cruciate ligament arthroplasty in knee joint in complete rupture of the ligament.

The aim is to carry out the analysis of outcomes of anterior cruciate ligament arthroplasty undertaken by various methods in patients with complete ligament rupture. Material and Methods. 104 patients diagnosed with complete rupture of anterior cruciate ligament (ACL) in knee joint who underwent knee joint arthroplasty fulfilled by various methods were the object of the present study. Clinical outcomes of the treatment were estimated by clinical signs of ACL failure, the degree of functional impairment of knee joint (IKDC 2000) and motor pathology assessed instrumentally. Results. Significantly better function restoration in knee joint occurring as early as 3 months postoperatively has been stated in the group of patients with two-bundle ACL arthroplasty by synthetic implant "DONA-M" on the basis of IKDC subjective knee indices. Negative Lachman test and Pivot shift test were demonstrated as early as 3 months postoperatively by all patients after two-bundle ACL arthroplasty with synthetic implant "DONA-M", reduced support asymmetry 6 months postoperatively was stated in all patient groups as well as run path and surface area in patients with single-bundle ACL arthroplasty by synthetic implant "DONA-M". Conclusion. The use of single- and double-bundle ACL arthroplasty with synthetic implant and ACL arthroplasty with autograft of semitendinosus (ST) and gracilis allows providing equally full-fledge restoration of injured knee joint, without statistically significant differences between the groups, in great majority of patients up to 12 months of follow-up period which is proved by normalized knee joint function, the absence of ACL failure and motor pathology signs estimated instrumentally. Key words: knee joint, anterior cruciate ligament (ACL), co</p

Professor Valeriy Vladimirovich Shchukovsky (to the 70th anniversary)

The article illustrates the life of Professor Valeriy Vladimirovich Shchukovsky and his scientific contribution into the development of separate branches of emergency medicine, namely intensive care of patients with embolism and acute thromboses of large vessels, severe thermal traumas, endotoxemia and multiorgan dysfunction syndrome, traumatic disease of spinal cord and its visceral complications in acute and early periods, reperfusion visceral injuries following its transplantation and patients with coagulopathic hemorrhage.</p