Genij Ortopedii最新文献

{"title":"Biological fixation of customized implants for post-traumatic acetabular deformities and defects","authors":"V. A. Bazlov, A. A. Pronskikh, A. A. Korytkin, T. Z. Mamuladze, M. V. Efimenko, V. V. Pavlov","doi":"10.18019/1028-4427-2023-29-6-609-614","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-6-609-614","url":null,"abstract":"Introduction The number of surgical interventions using additive technologies in medicine has been growing both in Russia and with every year. Due to the development of printing customized implants, the use of standard (imported) designs has decreased by an average of 7 % in the provision of high-tech medical care. However, the issue of the pore size of customized implants for management of post-traumatic defects in the acetabulum remains open.Objective To evaluate the results of the treatment of patients with post-traumatic acetabulum defects and deformities with the implementation in clinical practice of customized implants with structure and size porous surface that are optimal from the point of view of biological fixation.Material and methods Porous implants with different types of porous structure were produced by direct laser sintering using Ti-6Al-4V titanium alloy powders. Experimental work was carried out in vitro to determine the ability of living fibroblasts to penetrate the pores of different sizes. Next, the clinical part of this study was conducted in order to determine the signs of biological fixation of customized acetabular implants in a group of patients (n = 30).Results The results of this experiment performed to analyze the penetration of living fibroblasts into the porous structure of implants with different pore size demonstrated that metal structures with a pore size of 400-499 μm can be singled out from all others. Discussion Analysis of the literature data shows that there is no consensus on the structure and size of the pores of a customized implant. In our work, we investigated the ability of human living fibroblasts to penetrate into the surface structure of a customized implant, as a result of which we determined their optimal pore size of 400-499 microns. It should be noted that this study was conducted for a definite anatomical location: the acetabulum. However, it cannot be excluded that the data obtained are relevant for other anatomical locations.Conclusion Management of bone defects in the acetabulum area with customized implants featuring the surface pore size of 400-499 microns is a justified and relevant method. A prerequisite for the use of such implants is strict compliance with the indications for their use, careful preoperative planning and correct positioning.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138972816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical stimulation of distraction regenerate. Mini-review of current concepts","authors":"A. Cherkashin","doi":"10.18019/1028-4427-2023-29-6-656-661","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-6-656-661","url":null,"abstract":"Introduction One of the key limitations of distraction osteogenesis (DO) is the absence or delayed formation of a callus in the distraction gap, which can ultimately prolong the duration of treatment.Purpose Multiple modalities of distraction regenerate (DR) stimulation are reviewed, with a focus on modulation of the mechanical environment required for DR formation and maturation.Methods Preparing the review, the scientific platforms such as PubMed, Scopus, ResearchGate, RSCI were used for information searching. Search words or word combinations were mechanical bone union stimulation; axial dynamization, distraction regenerate.Results Recent advances in mechanobiology prove the effectiveness of axial loading and mechanical stimulation during fracture healing. Further investigation is still required to develop the proper protocols and applications for invasive and non-invasive stimulation of the DR. Understanding the role of dynamization as a mechanical stimulation method is impossible without a consensus on the use of the terms and protocols involved.Discussion We propose to define Axial Dynamization as the ability to provide axial load at the bone regeneration site with minimal translation and bending strain. Axial Dynamization works and is most likely achieved through multiple mechanisms: direct stimulation of the tissues by axial cyclic strain and elimination of translation forces at the DR site by reducing the effects of the cantilever bending of the pins.Conclusion Axial Dynamization, along with other non-invasive methods of mechanical DR stimulation, should become a default component of limb-lengthening protocols.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"10 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139002581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Solvent/non-solvent treatment as a method for surface coating of poly(ε-caprolactone) 3D-printed scaffolds with hydroxyapatite","authors":"V. S. Bocharov, G. Dubinenko, D. Popkov, A. Popkov, S. Tverdokhlebov","doi":"10.18019/1028-4427-2023-29-6-585-590","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-6-585-590","url":null,"abstract":"Introduction Over the last decades numerous new materials and techniques for bone tissue engineering have been developed. The use of bioresorbable polymeric scaffolds is one of the most promising techniques for surgical management of bone defects. However, the lack of bioactive properties of biodegradable polymers restricts the area of their application for bone tissue engineering.The aim of study was to apply solvent/non-solvent treatment to coat the surface of 3D-printed bioresorbable poly(ε-caprolactone) scaffolds with bioactive hydroxyapatite particles and report on the physicochemical properties of the resulting materials.Material and Methods In the present study, biomimetic poly(ε-caprolactone) scaffolds were 3D-printed via fused deposition modeling technology and their surface was treated with the solvent/non-solvent method for coating with bioactive particles of hydroxyapatite.Results It has been found that treatment in the mixture of toluene and ethanol is suitable for the coating of poly(ε-caprolactone) scaffolds with hydroxyapatite. The scaffolds maintain porous structure after treatment while hydroxyapatite particles form homogeneous coating. The amount of hydroxyapatite on the treated scaffolds was 5.7 ± 0.8 wt. %.Discussion The proposed method ensures a homogeneous coating of outer and inner surfaces of the poly(ε-caprolactone) scaffolds with hydroxyapatite without a significant impact on the structure of a scaffold. Fourier-transform infrared spectroscopy confirmed that the solvent/non-solvent treatment has no effect on the chemical structure of PCL scaffolds.Conclusion Coating of biomimetic 3D-printed PCL scaffolds with bioactive hydroxyapatite by the solvent/non-solvent treatment has been successfully carried out. Upon coating, scaffolds retained their shape and interconnected porous structure and adsorbed hydroxyapatite particles that were uniformly distributed on the surface of the scaffold.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138973107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Induction of bactericidal activity by degradable implants","authors":"A. Popkov, N. A. Kononovich, D. Popkov, N. V. Godovykh, S. Tverdokhlebov, E. Bolbasov, M. V. Stogov, E. A. Kireeva, E. Gorbach, Yu. Yu. Litvinov","doi":"10.18019/1028-4427-2023-29-6-596-601","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-6-596-601","url":null,"abstract":"Introduction The problem of implant-associated infections is far from being solved in arthroplasty, osteosynthesis of fractures, and spinal pathology. The development of biodegradable implants with bioactive properties is a promising direction. The purpose of this study was to evaluate the in vitro bactericidal activity of implants made from a degradable material polycaprolactone (PCL) impregnated with hydroxyapatite and an antibiotic.Material and methods To study antibiotic availability, antibiotic-impregnated PCL cylindrical samples (n = 6) were incubated in distilled water at 37 °C. To evaluate the antibacterial properties, samples in the form of porous disks were used: control samples from PCL; 1) PCL samples coated with antibiotic and hydroxyapatite; 2) PCL samples coated only with antibiotic; 3) PCL samples coated only with hydroxyapatite; (n = 6 for each type of tested samples). The disk diffusion method was used to determine the sensitivity of microorganisms to antibiotics. The microbial strains used were S. aureus ATCC 25923, P. aeruginosa ATCC 27853 and E. coli ATCC 25922. Test microorganisms were cultivated on beef peptone agar (MPA) at 37 °C for 24 hours. Quantitative data were subjected to statistical processing.Results It was determined that 82.6 % of the antibiotic was released during the first day of incubation and 8.2 % on the second day. Control samples did not show a bactericidal effect. Samples 3 showed an antibacterial effect against E. coli culture. Samples 1 and 2 equally demonstrated significant inhibition of the growth of S. aureus, P. aeruginosa, and E. coli.Discussion Most of the antibiotic is released into the hydrolyzate during the first two days of incubation. Porous implants made of PCL and impregnated with an antibiotic have pronounced antimicrobial activity against the most common gram-negative and gram-positive bacteria that cause purulent complications in surgical practice. Nanostructured hydroxyapatite on the surface of the implant does not reduce bactericidal activity.Conclusions Porous polycaprolactone implants filled with hydroxyapatite and antibiotics are targeted to stimulate bone regeneration and simultaneously ensure antimicrobial activity. Nanostructured hydroxyapatite on the implant surface does not decrease bactericidal activity.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"31 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138974826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the use of transosseous osteosynthesis in the treatment of patients with diabetic osteoarthropathy complicated by chronic osteomyelitis","authors":"A. Sudnitsyn, N. Kliushin, T. A. Stupina, G. Diachkova","doi":"10.18019/1028-4427-2023-29-4-388-394","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-4-388-394","url":null,"abstract":"Relevance Diabetic neuroosteoarthropathy (DNOAP) complicated by chronic osteomyelitis (CO) is one of the most common complications (up to 7.5 %) in patients with diabetes mellitus. Treatment failure of such patients leads to amputation of the segment, and in some cases, to death. The use of the method of transosseous osteosynthesis is the only alternative method in the struggle for the limb salvage.Purpose Based on X-ray morphological criteria for assessing bone quality, to determine the optimal assembly of the external fixation device (EFF), which provides favorable conditions for restoring limb weight-bearing capacity in the treatment of patients with DNOAP complicated by infection.Materials and methods The analysis of radiographs and the clinical course of the reparative process in 49 patients (mean age 55.5 ± 9.4 years) with DNOAP complicated by chronic osteomyelitis was carried out. Two groups were distinguished based on the Ilizarov apparatus assembly: wire-based (WB) used in 25 patients; hybrid construct (HC) in 24 patients. The X-ray obtained in Jpeg format were analyzed using specialized Hi-scene software. The density of the bones of the foot was studied by MSCT.Results Comparison of the indicators of bone optical density in both study groups showed that there was an insignificant increase in the postoperative period Od of the calcaneus by 25 % after treatment in patients from the HC group, and in the WB group by 43 % in the distal tibia. At the same time, we noted a significant increase in the Od values of the tibia in the postoperative period in patients from the HC group and in the body of the calcaneus in patients from the WB group. MSCT showed that the density of the calcaneus before treatment in patients with DNOAP in the region of the calcaneal tubercle was 194.37 ± 49.05 HU, in the region of the body it was 205.47 ± 38.36 HU, in the region of the distal tibia 280.00 ± 40.30 HU. The analysis of the results of bone osteosynthesis of the affected segment showed that the rate of satisfactory outcomes after dismantling the device in patients from the HC group was significantly higher than in the WB group (56 %) and amounted to 75 %.Discussion As is known, pronounced osteoporosis of the bones of the lower leg and foot is often characteristic of patients with diabetes mellitus complicated by DNOAP and chronic osteomyelitis. A possible arsenal of treatment methods that allow solving the problems of stable arrest of the osteomyelitic process and restoring limb support in such patients is very limited. The optimal choice of the Ilizarov apparatus assembly type has an impact on the outcome of treatment of patients with this pathology.Conclusion Based on X-ray morphological criteria for assessing bone quality, our study showed a decrease in optical  and densitometric bone density in patients with DNOAP complicated by chronic osteomyelitis compared to the norm. The use of wire-based assembly of the apparatus does not provide sufficient condit","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"17 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72472738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of culture-negative infection among infectious complications after total knee arthroplasty","authors":"L. Lyubimova, S. Bozhkova, N. N. Pchelova, E. V. Preobrazhenskaya, E. A. Lyubimov","doi":"10.18019/1028-4427-2023-29-4-402-409","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-4-402-409","url":null,"abstract":"Introduction Diagnosis of chronic periprosthetic joint infection (PJI) is difficult with the clinical signs of periprosthetic inflammation showing no growth of microorganism in the biomaterial. The frequency of culture-negative infection can reach 42.1 %. The objective of the study was to analyze outcomes of two-stage treatment of chronic PJI of the knee joint depending on the etiology of the infectious process.Material and methods A retrospective analysis of outcomes was produced for 103 patients: group I (n=30) showing no growth of microorganisms and group II (n = 73) demonstrating positive growth of pathogens. Knee PJI was diagnosed according to the 2018 ICM criteria. A favorable outcome suggested absence of recurrence for at least two years after reimplantation of endoprosthesis, arthrodesis, “life with a spacer” without signs of infection.Results Culture-negative infection was detected in 29.1 % (n = 30). Patients in the group were 1.5 times more likely to receive antibiotic therapy prior to admission and had average levels of CRP, ESR and articular leukocyte count being 1.5-2 times less than those in group II. Staphylococci (69.8 %) including MRSE (75 %) was the leading pathogen in group II. Recurrence of infection was 3.4 % in group I and 16.9 % in group II (p = 0.0928), the two-stage treatment was successful in 96.7 % and 74 %, respectively (p = 0.0064).Discussion Causes for the lack of growth of microorganisms in biological materials included previous antibiotic therapy, wound drainage, violations of the rules for sampling of biological material, absence of media for the growth of atypical microorganisms and the ability of microorganisms to form biofilms on implant surfaces. An emergency histological examination of the affected tissues was practical during surgery in doubtful situations for adequate surgical approach. The results of a meta-analysis (2023) showed that the replacement of an infected endoprosthesis was more effective for the treatment of a culture-negative infection compared to debridement and preservation of implant.Conclusion The culture-negative infection group in our series showed better success rate of a two-stage treatment of PJI using implant replacement and broad-spectrum empiric antibiotic therapy at a two-year follow-up period. The negative microbiological result in the group could be caused by antibacterial drugs administered prior to diagnosis of PJI.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85150600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic partial hindfoot amputation with injury to the posterior tibial artery","authors":"P. V. Iskusov, S. V. Bragina, A. E. Sovershaev, E. I. Sobolev, A. S. Zvorykin, E. P. Sharypova","doi":"10.18019/1028-4427-2023-29-3-419-424","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-3-419-424","url":null,"abstract":"Introduction Talus and calcaneus fractures account for about 2 % of skeletal injury and 70 % of the foot fractures. Open fractures of the hindfoot are diagnosed in 30 %. More than half of the injuries are graded as type III according to classification of R.B. Gustilo, J.T. Anderson (1976). Injury to the posterior tibial artery is observed in 6.4 % of patients. Amputations resulting from an osseous-vascular injury and gangrene and crushed soft tissues are observed in 3-60 %.The objective was to demonstrate a rare clinical case of traumatic partial hindfoot amputation on the right side associated with open calcaneus and talus fracture and injury to the posterior tibial artery and resulted in a good outcome.Material and methods A clinical case of a 36-year-old patient who suffered a traumatic partial hindfoot amputation and injury to the posterior tibial artery.Results Restoration of the anatomy and the function of the right foot was achieved in the patient.Discussion There are no clinical guidelines and a unified classification for bone and vascular injuries and no universal method for the treatment of a combined injury including an open fracture of bones and injury to blood vessels. The choice of treatment modality, diagnosis of osteovascular injuries are produced on an individual basis depending on the external and internal factors affecting the injuries. An angiotraumatological approach used to treat the patient with the hind foot injury on the right included early primary surgical treatment of the osteovascular injury, accurate reduction and stable fixation using a sparing technique for the calcaneus, repair of the posterior tibial artery, complex drug therapy to improve blood rheology, reduce coagulability, address tissue ischemia and provide adequate regional anesthesia.Conclusion The combination of factors and use of an angiotraumatological approach employing organ sparing strategy and a multidisciplinary team of orthopaedic and trauma surgeons, angiosurgeons, anesthesiologists-resuscitators facilitated foot salvage, improved function and supportability.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81339509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modeling the behavior of the acetabular axis and the axis of the ischial tuberosities during the transition from a standing to a sitting position","authors":"A. V. Peleganchuk, E. N. Turgunov, E. A. Mushkachev, N. V. Fedorova, M. N. Danilov, A. A. Korytkin, V. V. Pavlov","doi":"10.18019/1028-4427-2023-29-4-410-418","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-4-410-418","url":null,"abstract":"Introduction The success of the treatment of patients with degenerative diseases of the spine and concomitant damage to the hip joint depends on the understanding of the biomechanics of movements in the spinal-pelvic segment. After a thorough analysis of the biomechanical processes occurring in the spine-pelvis system during the transition from a standing to a sitting position, it becomes clear that the acetabular axis of rotation of the pelvis in space is not the only one.The purpose of the study was to develop and test a virtual model of the pelvis to study the kinematics of the movement of the spinal-pelvic complex with a description of the emergence of the iscial axis of rotation by changing the position from standing to sitting.Materials and methods The problem was solved using the finite element method. The bones were modeled as absolutely rigid bodies. The main ligaments and muscles were modeled using finite element springs: elastic fragments with specified rheological characteristics. The study of contact interaction was carried out for pairs: \"femoral head – acetabulum\" and \"ischial tuberosities - chair surface\".Results A new axis of rotation was revealed, the ischial axis, which corresponded to the points of initial contact of the ischial tuberosities with the surface of the chair. The axis of the acetabulum rotated by 7.1° relative to the ischial axis and at the final moment shifted in the horizontal direction relative to the acetabular axis by 8.83 mm. The gap between the surfaces of the femoral head and the acetabulum was about 8 mm.Discussion The study shows that the pelvis rotates depending on the position around two axes: acetabular and ischial ones, hence it follows that the acetabular axis oscillates back and forth during ante- and retroversion, that is, it is non-static. Shortcomings of the model: 1) muscles and ligaments were modeled using FE springs, the end and beginning of which were set by two points, and the muscles and ligaments in the real body are attached along the entire surface of the bones; 2) soft tissues were not modeled in real volume. The merit of the study is the contact interaction of the pelvis with the chair and its rotation relative to the ischial axis, while other studies consider the rotation of the pelvis only relative to the acetabular axis.Conclusion A new axis of rotation arises due to the contact interaction of the pelvic bone with the surface of the chair when the skeleton moves from a standing position to a sitting position, the ischial axis. The gap between the surfaces of the femoral head and the acetabulum was about 8 mm. It is advisable to conduct a clinical study.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90624780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary approach to the treatment of patients with periprosthetic joint infection of the hip complicated by injury to the great vessels","authors":"S. Oshkukov, D. A. Shavyrin, V. P. Voloshin, K. V. Shevyrev, D. Martynenko, A. G. Galkin, R. Larkov, Y. Kolesnikov, S. Zagarov, P. E. Ostanin","doi":"10.18019/1028-4427-2023-29-4-431-437","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-4-431-437","url":null,"abstract":"Introduction Total counts of total hip arthroplasty (THA) have been increasing for several decades, and the procedures are associated with considerable risk of intra- and postoperative complications. Vascular complications are defined as multiple pathological conditions. They are subdivided into acute adverse events such as intraoperative bleeding, acute ischemia and hematoma and chronic complications such as pseudoaneurysms and arteriovenous fistulas which can cause late ischemic events. A specialized and well-trained multidisciplinary team is required to perform surgical interventions due to the small number of intravascular lesions. The objective was to demonstrate findings of clinical, instrumentation methods and staged treatment of patients with periprosthetic joint infection (PJI) of the hip and complications associated with injury to the great vessels.Material and methods We report two cases of vascular complications in patients with PJI and migration of femoral components into the lesser pelvis.Results An integrated approach to the diagnosis and treatment of patients with PJI and complications associated with injury to the great vessels helped to avoid lethal outcomes of the Girdlestone operation.Discussion Revision THA requires careful planning and an interdisciplinary approach with the help of a clinical pharmacologist, microbiologist, plastic or angiosurgeon. PJI is associated with a high risk of recurrence that would require two-stage, three-stage surgical interventions. With the bone deficiency of the acetabulum and the proximal femur the Girdlestone operation is performed as the final procedure with resultant significant decrease in the functional adaptation of patients.Conclusion Careful preoperative preparation of patients with unstable hip replacement components including migration of the acetabular component into the pelvic cavity and associated PJI would help to avoid such a devastating complication as great vessel injury.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90956937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Features of organotopic remodeling of bone tissue and implanted osteoplastic material in Charcot neuro/osteoarthropathy","authors":"S. Osnach, V. Protsko, V. V. Kuznetsov, V. Obolensky, S. Tamoev, Yu. V. Khamidullina, D. Borzunov","doi":"10.18019/1028-4427-2023-29-4-395-401","DOIUrl":"https://doi.org/10.18019/1028-4427-2023-29-4-395-401","url":null,"abstract":"Introduction Despite the recognition of MRI as the gold diagnostic standard for Charcot arthropathy, there is evidence in the literature that MSCT is more informative for objective qualitative and quantitative diagnosis of the condition, primarily of the bone skeleton of the Charcot foot, in comparison with standard radiography. The sensitivity and specificity of these methods are different.Purpose To reveal the features of organotopic remodeling of bone tissue and implanted osteoplastic material in the course of midfoot and hindfoot subtotal defects management in Charcot neuro-osteoarthropathy.Materials and methods The analysis of bone tissue and implanted osteoplastic material density was carried out in a case series that included 11 patients with Charcot neuro-osteoarthropathy who underwent a two-stage procedure for bone defects in the hindfoot and midfoot with the Ilizarov apparatus. We studied CT and MRI scans and measured bone regenerate density before treatment, at the stages of transosseous osteosynthesis, and 3, 6, and 12 months after surgery.Results In all patients, varying increase in the amount and volume of bone tissue was visualized due to intensive periosteal bone formation along with the formation of bone ankylosis in the joints along combined with a consistent increase in the optical density of bone regenerates. The formation of the new bone tissue ran without the signs of lysis or sequestration. The conducted studies indicate that the sizes and architectonics of bone fragments are more differentiated in CT than in MRI scans.Discussion It is known that the bone, despite its high mineralization, continuously rebuilds, restores and adapts itself to certain functional conditions. This constant dynamic process of adaptive remodeling depends mostly on optimal blood supply, metabolic activity and the coordinated work of bone cell elements. The data obtained show angiogenesis in the compromised tissues in patients with Charcot foot and consistent remodeling of the graft into the new bone tissue.Conclusion The allobone in the composition of the combined bone graft does not reduce the likelihood of complete remodeling of the newly formed bone tissue. Higher bone density by filling in a bone defect with a graft differs from distraction regenerate that initially has low bone density. CT and MRI are highly effective and informative diagnostic methods for surgical treatment. In reconstructive interventions in the patients with Charcot foot under the conditions of transosseous osteosynthesis, preference among radiological study methods should be given to CT.","PeriodicalId":37426,"journal":{"name":"Genij Ortopedii","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77750801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}