FIVE YEAR OUTCOMES OF CERAMIC-ОN-CERAMIC AND CERAMIC-ОN-POLYETHYLENE BEARINGS IN HIP JOINT REPLACEMENT

In view of the increasing number of hip joint replacement volume there remains the key issue of improving prosthesis survivorship which directly depends on the friction couple. Material and methods. The authors have analyzed five year outcomes of two bearing types (head and insert) used in hip replacement: ceramic-on-ceramic (CoC) in 324 patients and ceramic-on-polyethylene (CoP) in 300 patients. Totally 550 patients were operated in the period starting 2010 till 2014, including 74 patients underwent bilateral hip replacement. The authors divided patients based on gender and also into three age groups: 20-40, 41-60 and 61-80 years old. The largest group comprised 156 women aged 41-60 years (28.4%). Additional grouping of patients was made based on gender, age and bearing diameter.36 mm diameter bearing was characterized of the most frequent use. Functional outcomes were assessed by Harris Hip Score. Statistical analysis was made with Statistica 10 software. Statistical significant was observed at p<0.05.Results.28 mm diameter bearing were rarely (19.5%) applied and mainly in women which is related to need for use of smaller acetabulum components and inability to implant a larger insert.36 mm diameter bearing were used most frequently, CoC articulation of36 mm was used in men in 34% of cases and in women – in 18.12% of cases.40 mm articulations were implanted in women two times less than in men which is related to a smaller diameter of acetabulum in women. Generally, CoC bearings were implanted more often in men which can be explained by a bigger social demand as well as a higher anti-luxation stability of large diameter bearings. Dislocations of implants occurred in 5 (0.91%) patients: in 4 patients with CoP bearingand in one patient with CoC articulation. Four revision procedures (0.64%) were made due to deep periprosthetic infection: two surgeries in each group. Harris Hip Score evaluation in CoC group demonstrated excellent and good outcomes in 99.2% of cases, and in CoP group – in 97.5% of cases.Conclusion. The authors observed no ceramic fractures or acoustic effects during 60 months follow up. It’s reasonable to increase CoC bearing diameter to achieve a better anti-luxation effect. CoC bearing selection should depend on patient’s activity and social demands but not only on the age. Based on study observations the authors forecast a higher survivorship of CoC couple within 15-20 years and expect to prove this conclusion in further studies

Comparative Evaluation of Custom-Made Components and Standard Implants for Acetabular Reconstruction in Revision Total Hip Arthroplasty

Background.The use of custom-made acetabular components is one of the promising methods for reconstruction of the acetabulum in cases of significant defects, including those associated with pelvic bone dissociation. It allows achieving stable fixation and restoring the biomechanics of the hip joint. Aimofthestudy to compare the results of using individually designed components, supportive antiprotrusion rings, augments, and hemispherical components in revision total hip arthroplasty for type IIIB bone defects according to Paprosky classification. Methods.The study analyzed the treatment outcomes of 90 patients with type IIIB bone defects who underwent revision total hip arthroplasty between 2017 and 2022. Patients were divided into three groups: the first group received individually designed acetabular components, the second group received augments with hemispheres, and the third group had antiprotrusion cages implanted. The analysis included the reasons for revision surgery, operation duration, blood loss volume, and type of revision procedure. Pain and functional outcomes were assessed with WOMAC, Harris Hip Score, and VAS scales. Results.3D-printed constructs were more frequently implanted in patients with pelvic bone dissociation. The first group showed a significantly positive dynamic in functional outcomes. Complications were diagnosed in 27 (30%) cases: joint instability (dislocation) in 10 (11.1%) patients, periprosthetic infection in 8 (8.8%), aseptic loosening in 4 (4.4%), and sciatic nerve neuropathy in 5 (5.5%) patients. The number of these complications was higher in the second and third groups of patients. Conclusion.Custom-made implants using 3D technologies are a preferable option for revision total hip arthroplasty in patients with type IIIB defects according to Paprosky classification, especially in cases of pelvic bone dissociation

Periprosthetic infection diagnosis. Part 1: serology

Periprosthetic joint infection continues to be a challenging problem. The demand for total joint arthroplasty is increasing, and the burden of such infections is increasing even more rapidly, and they pose a great problem due to economic reasons and poor outcomes. This review describes the current knowledge regarding diagnosis of periprosthetic joint infection with testing erythrocyte sedimentation rate, serum C-reactive protein, Interleukin-6 and some other novel approaches

CUSTOMIZED ACETABULAR COMPONENTS IN REVISION HIP ARTHROPLASTY

In recent years, there is a trend of increasing demand for revision hip arthroplasty. Among these patients there are many with complex acetabular defects, including patients with pelvic discontinuity. To ensure stability for revised acetabular components in such cases becomes a challenging or unachievable task. Such defects give indications for printing customized tri-flange acetabular component. The authors analysed own experience of creating and applying custom made acetabular components in 3 patients with complex acetabular defects. Material and methods. Among the patients there were 2 women and 1 man. Average age was 60,3±19,4 years (38 to 78 years). Two patients had III B defects with pelvic discontinuity and one patient had III A defect by Paprosky classification. As the first step, the authors in collaboration with engineers printed a plaster full size pelvic 3D model, as the second step a customized tri-flange acetabular component was designed and printed. Harris Hip Score was evaluated preoperatively and 3 months postoperatively. Results. Average follow-up period was 5,3±2,5 months (3 to 8 months). The authors observed no cases of implant loosening, dislocation or deep periprosthetic infection. Average Harris Hip Score before surgery was 27,13 and after surgery – 74,1 indicating a significant improvement in 3 months postoperatively. Conclusion. Indications for use of individual acetabular components in reported patients correspond to indications formulated by Berasi et al. The authors obtained encouraging early follow-up outcomes that correspond to data of other authors. In one patient certain difficulties were reported due to insufficient pelvic distraction. Component’s flanges prevented achieving adequate pelvic distraction. Nevertheless, good primary stability was achieved. Modern software and 3D metal printers can significantly reduce the production cost of customized acetabular components. Application of this technology can be widened to various orthopaedic centres and will undoubtedly improve the quality of treatment for such patients

2D planning for hip arthroplasty

Hip arthroplasty is a common surgery, the success of which largely depends on its planning. Traditionally, arthroplasty planning performed on X-ray film, but this method has many shortcomings, including the well-known systematic repression for analogue X-ray systems to digital. The wide range of implant templates for the planning available in numerous of foreign special planning programs for arthroplasty, but all of them are very expensive. A team of authors from Sechenov First Moscow State Medical University, Lomonosov Moscow State University and Petrovsky National Research Centre of Surgery developed an original computer program for hip arthroplasty planning that allows to plan not only in the DICOM format, but also in photographs of traditional X-ray film. In the process of their work, it has been proved that the projection distortion when photographing X-ray applied to the X-ray viewer without a tripod is 1.95%. Practical testing of the planning program was carried out with 316 total hip arthroplasty surgeries. It turned out that for acetabular component the number of matches was 301 (95.3%), and for femoral components - 304 (96.2%). There were no cases of changing the type of components during surgeries. Thus, the created domestic import-substituting planning program allows working with a variety of image formats and making it possible to digitize X-ray film

The impact of extended preoperative examination on the treatment tactics choice before the second stage of revision hip arthroplasty

Background. Reinfection and recurrence of periprosthetic infection rates during the second stage of revision hip arthroplasty (RHA) remain quite high. Performing preoperative diagnostic aspiration in patients with the installed hip spacer is a controversial issue. Aims of the study: 1) to compare the diagnostic accuracy, specificity and sensitivity of the used infection markers as a part of preoperative diagnostic protocols in order to exclude reinfection in patients with installed hip spacer before the second stage of RHA; 2) to analyze and compare the microbiological spectrum obtained at the stages of RHA. Methods. Diagnostic accuracy parameters of the used infection markers were assessed in order to exclude reinfection/recurrence in 107 patients with installed hip spacer. All patients were divided into two groups. In Group 1 (prospective), blood tests as well as diagnostic aspiration of synovial fluid were performed within the extended diagnostic protocol. In Group 2 (retrospective), the examination was performed according to the screening preoperative diagnostic protocol including blood tests. The used reference range of inflammatory biomarkers was based on the “small criteria” of ICM 2018. According to the results of the intraoperative microbiological examination of peri-implant tissue samples at the first and second stages of RHA, the analysis of detected microflora was conducted in order to assess probable reinfection/recurrence. Results. According to the results of the intraoperative microbiologic examination during the second stage of RHA, reinfection was detected in 40% of cases: in Group 1 — 9 cases, in Group 2 — 31 case. Synovial fluid was obtained from 85% of cases when preoperative diagnostic aspiration was performed. Synovial fluid could not be obtained in 15% cases (dry joint). Conclusion. Performing preoperative diagnostic aspiration before the second stage of RHA in patients with the installed spacer allowed choosing correct treatment tactics in 9% of cases. The parameters of diagnostic accuracy accounted for 82,6%. In the structure of detected pathogens in case of recurrence and reinfection, the representatives of Gram-positive coagulase-negative flora were the most frequent

Experimental and clinical justification of the use of probiotic-sorption drugs in veterinary surgery

The wide range of therapeutic effects of silicon dioxide (reduction of endogenous intoxication, normalization of intestinal microbiocenosis, reduction of systemic inflammatory response, activation of detoxification function) makes its use as a matrix in the production of pharmacological drugs for the treatment and prevention of surgical infection by giving an interesting direction for scientific research. The article provides experimental and clinical justification for the use of complex probiotic-sorption drugs in veterinary surgery in the treatment of various forms of surgical infection. Based on the results of the conducted research, the solution of an urgent scientific problem about the mechanisms of formation of microbiocenoses, improvement of methods of diagnosis, prevention and treatment of cats with surgical infections have been achieved. It is established that purulent-inflammatory processes in cats develop against the background of dysbiotic disorders of the microbial ecosystem of the intestinal tract, which has a certain prognostic value. The introduction to treatment regimens of probiotic-sorption drugs proved to be pathogenetically justified, which is confirmed by experimental and clinical studies. © Advanced Scientific Research. All rights reserved

The efficiency of therapy the piglets gastroenteritis with combination of enrofloxacin and phytosorbent hypericum perforatum l.

Pathology of the gastrointestinal takes the first place between all illnesses of internal organs of piglets. Piglet gastroenteritis is linked to various critical periods of their livelihood during which immunodeficiency disorders, activation of opportunistic microflora, intestinal dysbiosis appear. Uncontrollable use of antibacterial drugs causes the development of antibiotic resistance of bacterial pathogens. The research aims to study the efficiency of herbal sorbent Hypericum Perforatum L. in the context of complex therapy of acute piglets’ gastroenteritis. The therapy efficiency of herbal sorbent Hypericum Perforatum L. was studied in the context of complex therapy of 119 piglets. For the experiment were taken piglets of age 38,2±3,9 days, weight 6,6 ±0, 2 kg. Piglets of group I (n=51) having gastroenteritis were treating with the drug “Baytril” including enrofloxacin hydrochloride 10% as the active substance, dose 0,5 ml/10 kg of animals weight, which corresponds 5 mg/kg enrofloxacin hydrochloride intramuscularly, 1 time a day in 5 days. Piglets of the group II (n=68) having gastroenteritis were treating with the drug “Baytril” including enrofloxacin hydrochloride 10% as the active substance, dose 0,5 ml/10 kg of animals weight, which corresponds 5 mg/kg enrofloxacin hydrochloride intramuscularly, 1 time a day in 5 days with additional prescription of herbal sorbent Hypericum Perforatum L. in dose 2,0 g per os 1 time a day in 7 days. It was founded that combined therapy of piglet’s gastroenteritis using enrofloxacin hydrochloride and herbal sorbent Hypericum Perforatum L. leads to full recovery for 20,6% more frequently than therapy with enrofloxacin hydrochloride only. During the therapy of ill piglets with a combination of enrofloxacin hydrochloride and herbal sorbent Hypericum Perforatum L. the credible reduction of the phenomenon of the neutrophilic leukocytosis, increasing of the relative amount of T-lymphocytes, T-helpers, and B-lymphocytes, normalization of serum concentration of C-reactive protein, common protein and albumin was found. In the blood of ill animals treated with a combination of enrofloxacin hydrochloride and herbal sorbent Hypericum Perforatum L. comparing to piglets treated with enrofloxacin only the number of leukocytes in peripheral blood credibly reduced and the activity of T-and B-lymphocytes increased. These changes reflect credible anti-inflammatory and immunomodulating effects of the herbal sorbent based on Hypericum Perforatum L. in the treatment of piglet gastroenteritis. © 2020, Advanced Scientific Research. All rights reserved