Endoprosthesis Replacement Research Articles

The role of intraoperative cell salvage for musculoskeletal sarcoma surgery

BackgroundThe efficacy and safety of cell salvage for musculoskeletal sarcoma surgery have not been reported, and concerns over re-infusion of tumour cells remain. This study aims to i) describe the intra-operative blood loss and cell salvage reinfusion volumes for lower limb sarcoma and pelvic sarcoma procedures ii) and explore whether there is evidence of tumour cells in reinfused blood. MethodsRetrospective analysis of 109 consecutive surgical procedures for biopsy-proven sarcoma or bone metastasis performed between 1 July 2015 and 30 October 2019. Salvaged blood was processed and reinfused when intraoperative blood loss exceeded 500 ml. Primary bone tumour (n = 86(79%)) and metastasis (n = 23(21%) constituted the study group and surgeries were classified under hemipelvectomy (n = 43(39%)), lower limb endoprosthesis replacement (LLE) (n = 50(46%)) and wide excision surgery (WE) (n = 16(15%)). Microscopic examination of imprint cytology of leuco-depletion(LD) filters, and peripheral smear examination was performed for reinfused blood. ResultsMedian (IQR) intra-operative blood loss was 1750 (600–3000) ml for hemipelvectomy, 850 (600–1200) ml for LLE, and 1000 (550–2000) ml for WE. Salvaged blood was re-infused in 102 of 109 (94%) patients. The mean (SD) volume of re-infusion was 445(425) ml for hemipelvectomy, 206(131) ml for LLE, and 184(106) ml for WE. In total, 64 of 109 (59%) patients received an allogeneic red blood transfusion within 72 h of surgery. Cytology analysis of imprints taken from the filtered blood available in 95(87%) patients and peripheral smear examination of reinfused blood available in 32(29%) patients did not reveal evidence of tumour cells on microscopic examination of any samples. ConclusionOur study demonstrates that musculoskeletal sarcoma surgery is associated with significant blood loss, and cell salvage permits reinfusion of autologous blood in most patients. The cytological analysis did not reveal evidence of tumour cells in reinfused blood, consistent with other studies where cell salvage is used for cancer surgery.

Treatment strategies for tumor-related pathological fractures of the extremities

Pathological fractures of the extremities frequently lead to uncertainty with respect to the treatment strategy and timing. The origin of metastases is typically breast, bronchial, renal and prostate cancer and myelomas. Primary bone tumors play a subordinate role. The majority affect the femur, humerus and occasionally the tibia. Surgery is typically the first line treatment as healing under conservative treatment is unlikely. The most important goal is to relieve pain and the preservation or restoration of function. For correct assessment of indications, analysis of the fracture pattern and oncological aspects including dignity, entity, prognosis, metastatic status and the general condition of the patient need to be taken into consideration. Based on all these aspects the surgical approach can be chosen. Treatment options range from osteosynthetic stabilization and augmentation osteosynthesis up to endoprosthesis replacement. The treatment is carried out in an interdisciplinary procedure as additional measures need to be addressed in addition to the surgical treatment.

Distal femur aneurysmal bone cyst treated with two stages of surgery in the pandemic COVID-19 by excision-skeletal traction and endoprosthesis replacement: a case report

Introduction: An aneurysmal bone cyst (ABC) is benign but has a progressive nature that can cause severe problems if it occurs close to joints such as the knee. The ultimate goal of treatment is to remove the tumor, maintain limb function, and prevent a recurrence. Local therapy is still better than tumor resection. This study aims to describe a rare case about distal femur ABC treated with two stages of surgery in the pandemic COVID-19 by excision-skeletal traction and endoprosthesis replacement. Case description: A 31-year-old woman presented with a lump on the right knee. The patient has complained of limping. Open biopsy was performed, and the patient was confirmed to have ABC on the distal of her right femur. The patient had a leg length discrepancy of 8 cm. We decided to do skeletal traction first. One week after the skeletal traction, the patient undergoes endoprosthesis replacement. Conclusion: The management of wide excision of the tumor requires special postoperative attention. This is because aggressive measures can reduce the recurrence rate of tumors, but large reconstructions are also needed to maintain joint function.

Surgical management of primary bone sarcomas

This article aims to address the principles of surgical treatment of primary bone sarcomas including chondrosarcoma, osteosarcoma and Ewing's sarcoma of bone. This piece is aimed at serving as a guide to experienced orthopaedic surgeons who have limited knowledge of dealing with musculoskeletal tumours especially primary bone sarcomas. Important principles surrounding surgery involving bone sarcomas, principles of biopsy of such lesions and reconstruction techniques have been discussed. Limb salvage is the way forward in today's era and though endoprosthesis replacement is an important tool in a surgeon's armoury, biological methods of reconstruction have also shown to be effective in many settings. Chemotherapy and radiotherapy are vital adjuvant therapies associated with these sarcomas, and they have been discussed in this article.

Первичное эндопротезирование глазницы при энуклеации по поводу ретинобластомы

This review presents a cosmetic rehabilitation method in children with enucleated eye due to retinoblastoma – primary orbital endoprosthetics. General surgical approaches, implant types, cosmetic outcomes and complications are described within review. Primary orbital endoprosthetics in children with enucleated eye due to retinoblastoma is considered as safe and necessary method of pediatric rehabilitation. Key words: retinoblastoma, primary endoprosthesis replacement of the orbit, implants, chemotherapy, external beam therapy, pediatric rehabilitation.

ENDOPROSTHETIC REPLACEMENTIN PATIENTS WITH TUMORS OF BONES AND JOINTS: REVISION SURGERY

The article analyzes complications after individual oncological endoprosthesis replacement in tumor lesions of bones and joints, which led to repeated endoprosthesis replacement. After operations of endoprosthesis replacement of bones and joints with tumor lesions, the following complications were observed: periprosthetic infection — 7.4%, aseptic instability of the stem of endoprosthesis —13.1%, destruction of the endoprosthesis structure - 2.3%, wear of polyethylene inserts — 1.7%. Revision endoprosthesis replacement due to complications after endoprosthesis replacement of bones and joints for tumors was performed in 38 (21.7%) cases. Repeated endoprosthesis replacement of knee joint was performed in 22 cases, repeated endoprosthesis replacement of hip joint was performed in 6 cases, repeated endoprosthesis replacement of elbow joint was performed in 4 cases, repeated endoprosthesis replacement of shoulder joint was performed in 3 cases, repeated endoprosthesis replacement of tibial shaft was performed in 2 cases, repeated endoprosthesis replacement of ankle joint was performed in 1 case. The factors that led to complications and repeated endoprosthesis replacement were presented. In case of an infectious complication, it was recommended to install a metal-on-cement spacer, followed by repeated endoprosthesis replacement; in case of aseptic instability of the stem of endoprosthesis, repeated endoprosthesis replacement was performed with replacement of only one (loose) component of the endoprosthesis using a long intramedullary nail or replacement of the entire endoprosthesis; in case of the destruction of endoprosthesis structure, the repeated endoprosthesis replacement of the joint was effected with replacement of the entire endoprosthesis structure; when the polyethylene inserts were worn out, the repeated endoprosthesis replacement was performed with the replacement of the polyethylene inserts. After repeated endoprosthesis replacement, repeated revision operations were performed in 10 (26.3%) cases.

Surgical Treatment and Proposed Modified Classification for Harrington Class III Periacetabular Metastases.

ObjectivesThis study aims to: (i) evaluate the outcome of patients with Harrington class III lesions who were treated according to Harrington classification; (ii) propose a modified surgical classification for Harrington class III lesions; and (iii) assess the efficiency of the proposed modified classification.MethodsThis study composes two phases. During phase 1 (2006 to 2011), the clinical data of 16 patients with Harrington class III lesions who were treated by intralesional excision followed by reconstruction of antegrade/retrograde Steinmann pins/screws with cemented total hip arthroplasty (Harrington/modified Harrington procedure) were retrospectively reviewed and further analyzed synthetically to design a modified surgical classification system. In phase 2 (2013 to 2019), 62 patients with Harrington class III lesions were classified and surgically treated according to our modified classification. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) 93 scoring system. The outcome of local control was described using 2‐year recurrence‐free survival (RFS). Owing to the limited sample size, we considered P < 0.1 as significant.ResultsIn phase 1, the mean surgical time was 273.1 (180 to 390) min and the mean intraoperative hemorrhage was 2425.0 (400.0 to 8000.0) mL, respectively. The mean follow‐up time was 18.5 (2 to 54) months. Recurrence was found in 4 patients and the 2‐year RFS rate was 62.4% (95% confidence interval [CI] 31.6% to 93.2%). The mean postoperative MSTS93 score was 56.5% (20% to 90%). Based on the periacetabular bone destruction, we categorized the lesions into two subgroups: with the bone destruction distal to or around the inferior border of the sacroiliac joint (IIIa) and the bone destruction extended proximal to inferior border of the sacroiliac joint (IIIb). Six patients with IIIb lesions had significant prolonged surgical time (313.3 vs 249.0 min, P = 0.022), massive intraoperative hemorrhage (3533.3 vs 1760.0 mL, P = 0.093), poor functional outcome (46.7% vs 62.3%, P = 0.093), and unfavorable local control (31.3% vs 80.0%, P = 0.037) compared to the 10 patients with IIIa lesions. We then modified the surgical strategy for two subgroup of class III lesions: Harrington/modified Harrington procedure for IIIa lesions and en bloc resection followed by modular hemipelvic endoprosthesis replacement for IIIb lesions. Using the proposed modified surgical classification, 62 patients in the phase 2 study demonstrated improved surgical time (245.3 min, P = 0.086), intraoperative hemorrhage (1466.0 mL, P = 0.092), postoperative MSTS 93 scores (65.3%, P = 0.067), and 2‐year RFS rate (91.3%, P = 0.002) during a mean follow‐up time of 19.9 (1 to 60) months compared to those in the phase 1 study.ConclusionThe Harrington surgical classification is insufficient for class III lesions. We proposed modification of the classification for Harrington class III lesions by adding two subgroups and corresponding surgical strategies according to the involvement of bone destruction. Our proposed modified classification showed significant improvement in functional outcome and local control, along with acceptable surgical complexity in surgical management for Harrington class III lesions.

Assessment of Extra-Cortical Bone Bridge Interface in Cemented Mega Endoprosthesis for Limb Salvage Surgery.

Introduction:Mega endoprosthesis replacement for resection of primary malignant bone tumour requires immediate and long-term stability, particularly in the young and active patient. Extracortical bone bridge interface (EBBI) is a technique whereby autograft is wrapped around the interface junction of bone and porous-coated implant to induce and enhance bone formation for biological incorporation. This procedure increases the mean torsional stiffness and the mean maximum torque, which eventually improves the implant's long-term survival.Material and methods:The extracortical bone bridge interface's radiological parameter was evaluated at the prosthesis bone junction two years after surgery utilising a picture archiving and communication system (PACS). The radiograph's anteroposterior and lateral view was analysed for both thickness and length in all four cortices. The analysis was done in SPSS Version 24 using One-Way ANOVA and independent T-Test. Results were presented as mean and standard deviation and considered significant when the p-value was < 0.05.Results:The mean average thickness was 2.2293mm (SD 1.829), and the mean average length was 31.95% (SD 24.55). We observed that the thickness and length of EBBI were superior in the young patient or patients with giant cell tumour that did not receive chemotherapy, compared to patients treated for osteosarcoma. The distal femur also had better EBBI compared to the proximal tibia. However, the final multivariable statistical analysis showed no significant difference in all variables. EBBI thickness was significantly and positively correlated with EBBI Length (p<0.001). We conclude that, for each 1mm increase in EBBI thickness, the length will increase by 0.06% on average. About 17.2% of patients out of the 29 showed no radiological evidence of EBBI.Conclusion:From our study, there were no factors that significantly contributed to the formation and incorporation of EBBI

About the monograph by N. S. Nikolaev and R.V. Petrova “Physical rehabilitation of patients after endoprosthetics of large joints of the lower extremities”

The article presents the experience of implementing a systematic approach to medical rehabilitation of patients after hip and knee arthroplasty using the example of the Federal Center for Traumatology, Orthopedics and Endoprosthetics in Cheboksary. The monograph of the authors - direct participants in the process - contains practical recommendations, author's techniques, recommended complexes of physiotherapy after endoprosthesis replacement of large joints of the lower extremities.

Characteristics of Effective and Safe Methods of Treatment for Fresh Fracture-Dislocations of the Proximal Humerus

Aim The study was aimed to assess the results of treatment for fracture-dislocations of the proximal humerus (PH) within different time frames for optimizing treatment tactics. Patients and Methods This retrospective cohort study evaluated clinical outcomes of 25 patients with fracture-dislocations of the PH (15 patients were analyzed for short- and medium-term results, and 10 – for long-term results). The follow-up period ranged from 1 to 9-years. All patients underwent: clinical examination, constant score assessment and shoulder X-ray examination. Clinical, radiological and statistical methods were used for analysis. Results Assessment of the degree of initial displacement of tubercles and its impact on the results of treatment showed that significantly better results were obtained in case of displacement no more than 10 mm (p=0.041). Patients with displacement no more than 10 mm had an average score of 68.0±16.1 points (Mean=69.5), while those with displacement of the tubercle(s) exceeding 10 mm had an average score of 49.5±19.5 points (Mean=44). Analysis of the results of treatment showed that the delay in restoring normal anatomy of the PH or avoiding surgical interventions at all led to functional disorders of the shoulder joint. It was also demonstrated that neither patients, nor doctors were satisfied with the outcomes of the unipolar shoulder replacement (USR). Based on the results of the study, we proposed an algorithm for determining the tactics of surgical treatment in cases when a fracture-dislocation of the PH with complete dislocation of the fragment involving the articular surface of the humeral head is diagnosed. Conclusion The present study demonstrated some factors affecting the outcomes of treatment for fracture-dislocations of the PH. Current approaches for endoprosthesis replacement in these cases remain debatable and require further investigation.

Function and complications after endoprosthetic replacement of knee bone-forming tumors exposed to radiotherapy and multiagent chemotherapy

We discuss analysis of function outcome and complications in 65 patients undergoing endoprosthetic knee replacement for osteosarcoma after radiotherapy and multiagent chemotherapy. Specifically, we found that multiagent chemotherapy caused a periprosthetic infection in 7.7% of cases. Major complications of radiotherapy included periprosthetic infection (27.3%), bone fracture at the site of endoprosthesis stem implantation (27.3%), aseptic loosening of stem (18.2%) and in 9.1% of patients a post-radiation skin ulcer was observed. Strategies for eliminating complications of periprosthetic infection included: removal of the endoprosthesis, installation of a metal-cement spacer followed by repeated joint endoprosthesis replacement. Then metal osteosynthesis was performed with cover plates and cable grip in case of bone fractures at the site of endoprosthesis stem implantation. A revision knee replacement surgery was performed in case of aseptic loosening of stem; removal of ulcer, removal of necrotic tissue, wound revision, and wound closure by means of muscle reposition with the subsequent free skin grafting was carried out during removal of postradiation ulcer. Hip amputation or disarticulation of the thigh was carried out in case of recurrence; multiagent chemotherapy with metastasioctomy was performed in case of metastases in lung.

The role of radiation diagnostic methods in pathological changes of the hip joint before and after endoprosthetics

Endoprosthesis replacement-operational treatment of diseases and damages of hip joint. The problem of prevention of complications and their negative effects is extremely actual today. However the role of different beam techniques in identification of adverse effects and complications of endoprosthesis replacement of joints is studied insufficiently. Results of clinic and diagnostic and beam researches of 40 patients with pathology of hip joint are analyzed. The used beam methods of research - roentgenography, multispiral computed tomography. At presurgical stage the main objec­tive was detection of pathology of joint, definition of indications and planning of operative measure. Situation and relationship of components of endoprosthesis, condition of bone tissue, and also bone cement round cup and leg of prosthesis were key parameters of radiological assessment of outcomes of endoprosthesis replacement. Complex use of radiological techniques (roentgenography and spiral computed tomography) allows to specify and add semiotics of changes of bone tissue at the level of acetabular hollow and proximal department of femur after endoprosthesis re­placement.

COMPARATIVE ANALYSIS OF COMPLICATIONS IN PATIENTS AFTER INDIVIDUAL ONCOLOGICAL AND MODULAR ONCOLOGICAL ENDOPROSTHETICS OF THE KNEE JOINT WITH TUMOR LESIONS

The article contains analysis of complications after individual oncological knee joint endoprosthesis replacement in cases of tumor lesions. Complications were observed in 45 ,8% of cases after knee joint endoprosthesis replacement operations with tumor lesions. The main complications that were observed included infectious ones: 18,1%, aseptic instability of the endoprosthesis stem: 16,7%, bone fracture at the site of endoprosthesis stem implantation: 6,9%, destruction of the endoprosthesis structure: 4,2%. The factors that led to complications, as well as methods of their elimination are given. Dialysis and a long course of antibiotic therapy or the installation of a metal-cement spacer device followed by repeated endoprosthesis replacement is advised in case of an infectious complication. Repeated joint endoprosthesis replacement with replacement of only one (loose) component of the endoprosthesis, using a long intramedullary stem or replacement of the total endoprosthesis is advised in case of aseptic instability of the endoprosthesis stem. Metallic osteosynthesis of the periprosthetic bone fracture is performed using bone plates and cable grip in cases of bone fracture at the site of endoprosthesis stem implantation. Repeated joint endoprosthesis replacement is effected with replacement of the entire endoprosthesis structure in case of destruction of the endoprosthesis structure.

Oncoepidemiological situation of sarcomas in Kazakhstan

Abstract Background Sarcoma is a malignant tumor of soft tissues and bones. They make up 1% of all malignant tumors in adults and 15% in children. More common in men 1.1: 1. By age: 20.7% - up to 40 years old, 27.6% - 40-60 years old and 51.7% over 60 years old. In 2018, in the Kazakhstan, malignant tumor of connective and soft tissues of 444 (1.4%) cases was registered and ranks 19th in the structure of cancer, bones and articular cartilage 188 (0.6%), takes 22nd place. Of these, with sore cases, bone sarcomas were recorded - 12.7%, soft tissues - 9.5%. The mortality rate from soft tissue sarcoma is -177 (1.2%) people, bone sarcoma - 85 (0.6%) people. Five-year survival of patients from soft tissue sarcomas is 53.8%, from bone sarcomas - 67.3%. Methods from 2015 to 2019, 1,068 patients with malignant tumor of bones and articular cartilage, 963 patients with malignant tumor of connective and soft tissues addmited to KazNIIOiR. Of these, 225 patients underwent organ-sparing surgeries - endoprosthesis replacement of limbs. Results In Kazakhstan over the past 5 years there has been an increase in the incidence of sarcomas of bones and soft tissues. Conclusions in comparison with previous years, there is an increase in the incidence of malignant tumor of bones and articular cartilage, connective and soft tissues, and an increase in mortality from tumor of bones and articular cartilage in men by 16.7%, in women by 50%. Late reversal of patients at the IV stage and a high proportion posthumously recorded in patients with maliganan tumors. Key messages Purpose: Assessment of the epidemiological situation and incidence of sarcomas of the bones and soft tissues in Kazakhstan. Out of 25 localizations of cancer, detection is worsened during professional examinations in 10 localizations, of which bones and articular cartilage, connective and other soft tissues.

Optimization of total hip arthroplasty for dysplastic coxarthrosis

Degenerative-dystrophic hip damages are among urgent problems, for which endoprosthesis replacement is considered a relevant solution for 100 to 300 cases per 100,000 population per year. Aseptic instability of the endoprosthesis components dominates the environment of unsatisfactory outcomes in the long term. To prevent aseptic instability of the hip endoprosthesis components in the hip pathology, the authors propose a method of "incision" on the tendon part m. iliopsoas and use of the intraoperative method to determine the centre of the endoprosthesis head rotation. This work analyses the surgical treatment method of 103 patients operated on in the traditional way and 91 patients who underwent surgical incision of the m.iliopsoas tendon using the intraoperative method to determine the centre of the endoprosthesis head rotation.

PCR research as an auxiliary method for diagnostics of periphresitical infection after endostreditision of joints (clinical case).

Periprosthetic infection (PPI) after arthroplasty of large joints is the third (among the main causes of unsatisfactory results of surgical treatment) a serious threat to the health of patients. The «gold standard» for the diagnosis of PPI is the bacteriological examination of samples of periprosthetic tissues and synovial fluid. In 10-30% of cases, it is impossible to isolate microorganisms, which is explained by the difficulty of cultivation and taking antibiotics before sampling. The purpose of study is to demonstrate the diagnostic value of PCR diagnostics for identifying the genetic material of an infectious pathogen of a culture-negative periprosthetic infection. Material of the study is a description of a clinical case of a culture-negative periprosthetic infection that caused a second two-stage revision of the hip joint prosthesis In the first episode of PPI that occurred 3 years after hip replacement, a microbiological examination of the puncture of the trochanteric zone of the operated joint revealed a massive increase in methicillin-resistant Staphylococcus epidermidis (MRSE). A two-stage revision joint replacement was performed. 5 years after the revision, the patient was hospitalized with clinical and radiological signs of PPI, while examining the puncture of the joint revealed characteristic PPI cytosis. Microbiological examination of punctate and intraoperative aspirate at the first stage of the repeated two-stage revision endoprosthesis replacement did not reveal aerobic and anaerobic microorganisms. In PCR studies, the DNA of methicillin-sensitive Staphylococcus aureus (MSSA) was detected in washouts from the removed components of the endoprosthesis; no resistance marker (mecA gene) was found. Given the concomitant oncological disease, this result determined the appointment of pathogenetic antibiotic therapy, the effectiveness of which was confirmed after 8 weeks at the II stage of revision. The PCR study of joint and trochanteric punctures (before surgery), flushing from the removed spacer components (after ultrasound treatment) and intraoperative aspirate from the joint did not reveal Staphylococcus aureus DNA and resistance marker (mecA gene). In some cases of periprosthetic infection, traumatologists and orthopedists deal with culturally negative results of a microbiological study of the patient's biomaterial and swabs from the components of endoprostheses in the presence of clinical manifestations of PPI, confirmed by laboratory diagnostics and X-ray examination. According to the literature, such clinical situations are observed in 10-30% of cases and are caused by previous antibiotic therapy in the early stages of an infectious complication. After surgical treatment of PPI for the selection of adequate antibiotic therapy, such patients need to at least indirectly determine the type of infection pathogen, which is achieved by the use of additional diagnostic methods, such as a PRC study. In the case described by us, after a course of antibiotic therapy, prescribed according to the results of the first PCR study, the patient's body does not contain DNA traces of the desired infectious agent. Thus, the repeated PCR not only confirmed the accuracy of the initial diagnosis of the source of infection, but also further illustrated the success of the rehabilitation of the periprosthetic infection using a correctly selected antibacterial drug at the previous stage of the study. The use of the PCR method made it possible to diagnose the pathogen and prescribe adequate antibiotic therapy for culture-negative periprosthetic infection.

Segmental endoprosthesis replacement in a resource-constrained setting.

Indications for the use of endoprosthesis have continued to expand over the years, especially as an alternative to ablative surgery. This mode of treatment which was initially limited to orthopaedic oncology is now being applied in complex trauma with significant bone loss and end-stage arthroplasty. However, use of endoprosthesis in a resource-constrained setting such as sub-Saharan Africa is limited by various factors. These factors include high cost of endoprosthesis, restricted availability of appropriate equipment and the requisite trained specialists in the field. Twelve patients who had segmental endoprosthetic replacement for various aetiologies were studied in this case series. Resection lengths, complications and functional outcomes were noted. The resection length varied between 12 and 27cm. Using the Henderson classification system, one patient (8.3%) had a Type 1A complication, one had a Type 3A complication (8.3%), and two patients had Type 4A complications (16.6%). Functional outcomes were graded using the MusculoSkeletal Tumour Society scoring system, and scores were good to excellent in ten patients, moderate in one and poor in one patient. Early results indicate fair outcomes; however, factors limiting the use of endoprosthesis still persist. These include high cost of endoprosthesis, restricted availability of appropriate equipment and the requisite trained specialists in the field.

COMPARATIVE ANALYSIS OF COMPLICATIONS IN PATIENTS AFTER INDIVIDUAL ONCOLOGICAL AND MODULAR ONCOLOGICAL ENDOPROSTHETICS OF THE KNEE JOINT WITH TUMOR LESIONS

The article contains analysis of complications after individual oncological knee joint endoprosthesis replacement in cases of tumor lesions. Complications were observed in 45,8% of cases after knee joint endoprosthesis replacement operations with tumor lesions. The main complications that were observed included infectious ones: 18,1%, aseptic instability of the endoprosthesis stem: 16,7%, bone fracture at the site of endoprosthesis stem implantation: 6,9%, destruction of the endoprosthesis structure: 4,2%. The factors that led to complications, as well as methods of their elimination are given. Dialysis and a long course of antibiotic therapy or the installation of a metal-cement spacer device followed by repeated endoprosthesis replacement is advised in case of an infectious complication. Repeated joint endoprosthesis replacement with replacement of only one (loose) component of the endoprosthesis, using a long intramedullary stem or replacement of the total endoprosthesis is advised in case of aseptic instability of the endoprosthesis stem. Metallic osteosynthesis of the periprosthetic bone fracture is performed using bone plates and cable grip in cases of bone fracture at the site of endoprosthesis stem implantation. Repeated joint endoprosthesis replacement is effected with replacement of the entire endoprosthesis structure in case of destruction of the endoprosthesis structure.

The evaluation of polyclinic rehabilitation after prosthetic arthroplasty

The study considers quality of assessing functioning, limitation of vital activity and patient participation in outpatient stage of rehabilitation according traumatology and orthopedics profile. The sampling included 712 out-patient records of patients with complete endoprosthesis replacement of hip (299 or 42%) and knee (413 or 58%) joints. The study analyzed application of the Haris, Leken and Rankin scales, hospital anxiety and depression scale (HADS), quality of life questionnaire (EQ-5D), recommended as mandatory examination tools in case of rehabilitation after endoprosthesis replacement. The statistical data processing was performed using software IBM SPSS Statistics version 23. It is established that Harris and Leken scales, hospital anxiety and depression scale (HADS) were not applied to any patient. The functional structural deformation of joint and/or limb with detailed elaboration of degrees and centimeters is described in 10% of medical records, but it completely matches data from hospital case records. At completion of rehabilitation cycle, 55.9% of all primary complaints are repeated in final diaries. What is regarded 39.3% of primary complaints, there is no information about their elimination. In 25.9% of patients in their final diaries the complaints are present that were not indicated after primary and subsequent examinations. The evaluation according both modified Rankin scale (13.1% of patients) and the quality of life questionnaire (EQ-5D) (6.9% of patients) was implemented only in case of referral to medical social expertise examination. The out-patient rehabilitation cycle was uncompleted in 26% of patients.

Outcomes of Revision Arthroplasty of Large Joints with Periprosthetic Infection

The article presents an analysis of the results of treatment of 62 patients with deep periprosthetic infection of the hip and knee joints who underwent revision arthroplasty. The age of the patients is from 37 to 81 years (mean age 62.7 ± 3.21 years). Men made 51.6 % of all patients. Periprosthetic infection after hip replacement occurred in 34 patients, knee joint - in 28 patients. There were 67 completed revision interventions. The analysis showed that the use of revision endoprosthetics for periprosthetic infection made it possible to stop the infection process in 68.7 % of cases. In case of one-stage revision endoprosthesis replacement, unsatisfactory results in terms of stopping the infection process amounted to 31.8 % of cases. Of these, subsequently in 8 patients (57.1 %) the endoprosthesis was removed with the subsequent formation of ankylosis of the knee joint and neoarthrosis of the hip joint. An unsatisfactory result of two-stage revision endoprosthetics was obtained in 38.9 % of cases. Of these, in 6 cases (85.7 %), the infectious process was not stopped at the stage of spacer installation. The analysis of cases of unsatisfactory results of revision endoprosthetics was carried out taking into account the method we developed for determining the surgical tactics of revision endoprosthetics of large joints in case of infectious complication, based on establishing the degree of risk of maintaining the infectious process. In addition, adverse factors that prevented the relief of periprosthetic infection were identified. As a result of the analysis, it was revealed that the reason for the unsatisfactory result of one-stage revision endoprosthetics in 12 cases was the wrong choice of the type of revision intervention. When planning a two-stage revision endoprosthesis replacement, it is necessary to take into account factors such as an allergy to antibacterial drugs, multiple surgical interventions on the affected joint, and extensive bone defects in the endoprosthesis area.