THE ROLE OF MULTISLICE COMPUTED TOMOGRAPHY IN PRIMARY KNEE REPLACEMENT

The paper describes a clinical case of planning knee arthroplasty using up-to-date radiological methods. The possibilities and advantage of multislice computed tomography (MSCT) are assessed. MSCT allows the careful planning of knee replacement and also estimation of the position of components after arthroplasty with smaller amounts of radiation of the patient for a short time

TOTAL HIP AND KNEE ARTHROPLASTY IN PATIENTS WITH CHRONIC KIDNEY DISEASE (REVIEW)

Chronic kidney disease is a common medical problem. It is characterized by a peculiar course leading to renal osteodystrophy resulting in increased risk of fractures and joint lesions with the concomitant need for major joints arthroplasty. Moreover, a wide spectrum of organ and metabolic deteriorations due to renal insufficiency causes a more complicated postoperative period with higher mortality and frequent infectious, cardiovascular, hemorrhagic, thrombotic and surgical complications. The highest risks are noted in patients on long lasting hemodialysis.To improve the arthroplasty outcomes an adequate correction of anemia, bone-mineral and electrolyte disorders, arterial hypertension and optimization of dialytic modalities must be ensured

THE ROLE OF MULTISLICE COMPUTED TOMOGRAPHY IN PRIMARY KNEE REPLACEMENT

The paper describes a clinical case of planning knee arthroplasty using up-to-date radiological methods. The possibilities and advantage of multislice computed tomography (MSCT) are assessed. MSCT allows the careful planning of knee replacement and also estimation of the position of components after arthroplasty with smaller amounts of radiation of the patient for a short time

Postoperative Analgesia after Total Knee Arthroplasty: a Comparative Analysis of Current Treatment Techniques Effectiveness

The objective of the study was to evaluate the effectiveness and safety of high-volume local infiltration and epidural analgesic techniques after primary total knee arthroplasty versus standard systemic multimodal analgesia in the context of the postoperative analgesia protocols.Materials and Methods. A single-center randomized comparative study included 84 patients who, from august 2017 to august 2018, underwent a primary total knee arthroplasty. Depending on the method of postoperative analgesia, we randomized patients into 3 groups. Group A consisted of 32 patients who received intraoperative infiltration of periarticular tissues with 0.2% solution of ropivacaine in combination with adrenaline and subsequent bolus injection of a local anesthetic solution via a catheter inserted into the wound. Group B included patients who received epidural analgesia with a constant infusion of a 0.2% solution of ropivacaine (n = 28). In patients of group C, neither regional nor local analgesia techniques were used for postoperative analgesia (n = 24). All patients received standard systemic multimodal analgesia using nonsteroidal anti-inflammatory drugs and tramadol. The pain intensity was measured by vas when the patient was motionless, and during knee flexion (before surgery, after surgery on resolution of motor block and during the initial postoperative 24 h), side-effects were recorded.Results. The patients of Group C, during knee flexion in the postoperative period, reported the highest pain scores (6 (5; 8) during the initial postoperative 12 h and 6 (5; 6) during the initial postoperative 24 h). Severe pain, resistant to therapy and requiring the administration of narcotic analgesics (morphine 1.0 mg), was noted in 5 (15.6%) patients in group A and in 10 (41.6%) in group C, in contrast to patients of group B, where no pain was recorded in any patient, p = 0.056, p = 0.037 and p<0.0001. Hypotension was observed only in group B in 6 (22%) patients. Intra-articular and other infectious complications among all patients were not recorded.Conclusion. High-volume local infiltration analgesia as a modality of postoperative analgesia is not inferior in the effectiveness to the epidural analgesia, does not require strict monitoring and is accompanied by a lower incidence of side-effects and complications, which can make it the procedure of choice in multimodal analgesia schemes for total knee arthroplasty

Hip Arthroplasty in Patients with Hip Dysplasia by Individual Augments: Early Results

Relevance. The altered hip anatomy makes total hip arthroplasty in patients with hip dysplasia a difficult and non-standard task. The acetabulum is deformed with femoral head in subluxation or dislocation. The most important task of surgery is to restore the anatomical position of the hip center of rotation.The study purpose — to evaluate the early results of hip arthroplasty with individual augments in the patients with hip dysplasia.Materials and Methods. Since 2017, nine patients with hip dysplasia have undergone surgery using individually printed augments. All patients were women with average age 51.3±14.5 years (23 to 67). The mean follow-up was 14.3±5.2 months (8 to 20). Patients were evaluated using follow-up X-rays, a visual analogue scale (VAS), Harris Hip Score (HHS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC).Results. There was no a single case of endoprosthesis dislocation, loosening of components, prosthetic infection or revision surgery in the analyzed group of patients. The planned sizes of the acetabular components were equal to the placed in 7 cases (77.8%). In two cases (22.2%), the acetabular components were 2 mm larger because the surgeon wanted a greater degree of press-fit fixation. The restoration of the anatomical position of the acetabular component was noted. Before the surgery, the femoral head was on average 22.7±11.7 mm (10 to 43 mm) higher. After the surgery, the level of the acetabular component was on average only 0.75±2.1 mm (1.7 to 5 mm), p = 0.008. Also, there were a decrease in pain and quality of life improvement by VAS from 6.78±1.39 before surgery to 2.22±1.09 at follow-up (p = 0.007), HHS increase from 30.5±18. 1 to 77.59±14.26 (p = 0.008), and WOMAC decrease from 73.3±14.1 to 18.22±8.2 (p = 0.008).Conclusion. The individually printed augments have shown high efficacy for restoration of the anatomical center of rotation and good early results in the patients with hip dysplasia undergone hip arthroplasty

Total cement knee arthroplasty in patients of 85–95 years old with terminal stage of degenerative knee disease

The objective of the study is to make the analysis of the results of total cement knee arthroplasty in the most difficult age group of 85–95 years old patients.Material and methods. 40 patients with terminal knee arthrosis were selected based on their comorbidity.Results. Patients with the Charlson comorbidity index of 5–8 points need hospitalization for the treatment of aggravating somatic pathology, as preparation for a future knee arthroplasty. In the operated patients, the result on the KOOS was (76±7.19), and on the WOMAC was (151±4.83) a year after the arthroplasty.Сonclusion. Surgical intervention – total knee arthroplasty in patients of 85–95 years old is possible only if its risk is minimized