Aim

In surgeries on patients with advanced ligament instabilities or severe bone defects modern-generation of rotating hinged knee prostheses are one of the main options. The objective of our study is to evaluate the mid-term functional results and complications of several surgeries using this form of prosthesis.

Modern prosthetic stem construction strives to achieve the attractive goals of stress shielding prevention and optimal osteointegration. PhysioLogic stem is a new generation composite isoelastic femoral stem consisting of titanium core sheathed in implantable PEEK polymer and coated with titanium layer. This construction combines the benefits of both stress shielding prevention, due to its elasticity under bending load corresponding closely to that of natural bone, and rapid osteointegration, due to the stem's titanium coating.

The aim of this study is long-term clinical progress evaluation and retrospective analysis in patients undergoing primary PhysioLogic stem implantation at our institution.

From 1998 to 2003, we performed 51 primary total hip arthroplasty (THA) operations with implantation of PhysioLogic Stem at our institution. Indications for THA included osteoarthritis (21), hip dysplasia (14), rheumatoid arthritis (10), and femoral neck nonunion (6). In all patients we used totally uncemented system — PhysioLogic Stem and monoblock cup with different types of bearing surface articulation (40 metal/polyethylene, 3 ceramic/polyethylene, and 8 metal/metal). In all cases head size was 28mm. Two patients died in the early post-op period at day 1 and day 9 from disseminated intravascular coagulation and pulmonary embolism, respectively, and were excluded from subsequent analysis. Analyzed patients included 20 women and 29 men; median age 45, range 21–69. Post-operatively, the patients were evaluated at 3 and 6 months, 1 year, and yearly thereafter. Median follow-up period was 14 years, range 11 to 16 years. Clinical and functional outcomes were evaluated by Harris Hip Score. Bone density in Gruen's and Charnley's zones was measured by dual-energy x-ray absorptiometry.

Four patients died at 5–8 years postoperatively from cardiac causes. Two patients underwent revision surgery: one patient underwent “dry revision” due to hip dislocation with exchange for longer head while keeping the original PhysioLogic stem in place; second patient underwent stem removal after chronic periprosthetic infection. Among the 45 patients with surviving PhysioLogic Stem, 33 patients (75%) underwent subsequent contralateral total hip arthroplasty with standard uncemented stems types Spotorno or Zweymuller. These patients were surveyed at postoperative evaluation about subjective comparative performance of PhysioLogic Stem versus standard stem. Twenty seven patients (82%) reported the PhysioLogic stem to be equivalent or superior to the standard stem, with 15 patients (45%) rating the PhysioLogic stem as subjectively more comfortable than the standard stem.

The average Harris hip score improved from 40 points preoperatively (range 27 to 48) to 93 points (range 89 to 95) at the time of final follow-up. All stems continue to show adequate bone-ingrown fixation with no radiological signs of aseptic loosening to date. The PhysioLogic stem removed in the aforementioned case of chronic periprosthetic infection also showed clear signs of good osteointegration.

Our study showed that the PhysioLogic stem implantation resulted in favorable clinical and functional performance at long-term follow-up, making it an attractive alternative to standard stems.

Introduction. The problem of prophylaxis and treatment of infected complications after total joint replacemt is relevant today, especially in case of revision procedures. The important factor in successful preventive maintenance and treatment of purulent complications is reduction of so-called ‘dead space’ of the operated joint usually filled with a haematoma. Traditionally reduction of this ‘dead space’ has been surgically approached, for example, by filling the cavity of a joint with muscular tissue.

The purpose of this study is to analyze the effects of different methods of ‘dead space’ reduction in treatment of infected complications in total joint replacement.

Materials and methods: Follow-up results of 237 operations for treatment of infected hip and knee joints have been studied. Patients were observed from 2 to 12 years (average 7 years). 3 groups of patients have been allocated. The first group (87 patients) was formed by patients with signs of early infected postoperative complications after total hip or knee joints arthroplastics. In this group only debridement of necrotic tissues was performed. The second group (48 persons) consisted of patients with signs of a chronic infection after total joint replacement. In all these patients, after removal of the purulent and necrotic tissues, the one-stage revision was carried out. The third group included 102 patients who underwent a two stage revision and application of the articulating spacer. In each group two methods? of ‘dead space’ reduction – muscular tissue tamponade or filling of articular cavity by Taurolin-Gel 4% – were performed. Depending on the volume of joint and intramedullary cavity at operation, 50 to 100 g of Taurolin-Gel were used.

Results: Between all the groups the infection recurrence was observed in 21 patients (8,86%). The best results were observed in patients with early infection and in cases of two stage revisions. On the average, filling the joint cavity with Taurolin-Gel during revision surgery, in contrast to the muscular tissue tamponade, reduced the frequency of repeated infected complications by the factor of 1,6.

Discussion: Taurolin-Gel 4%, inserted into joint cavity, acts not only as a haematoma displacement, but also as a good antibacterial agent. It creates a depot of the antimicrobic medicine directly in the pathological center. By deleting a hematoma, we sharply reduce the risk of infectious complications in the postoperative period. Besides, Taurolin-Gel reduces postoperative blood loss by approximately 30%, causing mechanical haemostasis by the tamponade.

Conclusions: In contrast to filling a joint cavity with muscular tissue, using Taurolon-Gel 4% is much easier technically, more effective in reducing the infection occurrence, greatly reduces the time of revision intervention, and reduces the general traumaticity of operations.

The problem of prophylaxis and treatment of infected complications after total joint replacement is relevant today, especially in case of revision procedures. The important factor in successful preventive maintenance and treatment of purulent complications is reduction of so-called «dead space» of the operated joint. Aim of this study is to analyze the Taurolin-Gel 4% application for “dead” space filling in patients with high risk of wound infections after total hip replacement.

Follow-up results of 178 operations with Taurolin-Gel 4% application have been studied. Patients were observed from 2 to 12 years (average 6 years). All patients were divided on 4 groups. First group consisted of 46 patients with early postoperative infected complications; second group (38 patients) was with first step of two-step revision in chronic infection. Third group included 35 patients on second stage of two-stage revision and fourth group consisted of 59 patients with medical history of infected problems in affected joint. In all four groups the infection recurrences after Taurolin implantation were noted in 6 patients (3,4 %).

Taurolin-Gel 4%, inserted into joint cavity, is not only a good local antibacterial agent, but it also fills up “dead” spaces in the affected joint and displaces haematoma. Deleting a haematoma, which is the favourable environment for bacterial functioning, risk of infections complication in the postoperative period reduces. Besides, Taurolin-Gel decreases postoperative blood loss for approximately 30 %, causing mechanical haemostasis. In difference from filling of a joint cavity with the moved muscular tissue, Taurolin Gel 4 % using are much easier technically, reduces time of revision intervention and traumatic of operation.

Introduction Distal radius fractures are the most common in the upper extremities and usually comminuted and unstable. The following techniques are usually used in treating these fractures: osteosynthesis with plates and screws (ORIF), Ilizarov device and the AO- external fixator, K – wires.

The main aim of the report is to study the results of surgical treatment of distal radius nonunion, malunion, and pseudarthrosis in cases when different techniques of fixation were used.

Material and methods. In 1998–2001 a clinical study of 48 patients (33 males and 15 females) with distal radius injury was conducted in orthopedics department. The mean age of the patients was 42 years (15–69). 28 patients had the injury of their right hand and 20 - of their left hand. 19 patients had distal radius non-union, 15 – malunion, and 14 – pseudarthrosis. The average time from injury to the surgical treatment was 5 months. The mean follow-up was 27,2 Months (12–36). The AO techniques (ORIF with titanium and stainless steel implants) were used in Group I (36 patients). Conventional techniques and fixators were used in 13 patients of Group II: home produced plates and screws, Ilizarov device, external fixator, K- wires. The indications for surgical treatment nonunion were: A3 type, B1 – B3 type, C1 – C3 type, accompanied by more than two criteria of instability. In 10 patients with extraar-ticular fractures we used osteosynthesis with dorsal or palmar T-plates (3.5 mm). Mini-«T» - and «Pi»-Plates (2,7 mm) were used in four patients who had comminuted fractures with tiny distal fragments (‘bursting’ mechanism).The Ilizarov device and K-wires were used in five patients. Radius reduction without rotational and angular deformity was considered to be an indication for shortening osteotomy of the ulna. Internal fixation with a 3.5 mm LC-DCP plate was used in six patients of Group I, and K- wires were used in two patients of Group II. The deformity of the radius required corrective osteotomy with a 3.5 mm T-plate fixation in five patients of Group I, in two patients of Group II we used home produced plates, screws, and bone autoplasty with a spongy graft from the iliac crest (14); in one patient a «Bio-oss» graft was used. In 7 patients we used Ilizarov device and K-wires.

Results. Pain relief was achieved in 87% of the reexamined patients from the Group I and in 72% - from the Group II. Bone fragments united in 31 patients of Group I (86%) and in 9 patients (75%). In one case a plate broke resulting in the relapse of pseudarthrosis. Application of the AO fixators allowed early mobilization, which helped to avoid post immobility contractures. Grasping power restoration in Group I was 76% (grip strength) and 82% (pinch strength) of the uninjured side. In Group II grip strength was 55% and pinch strength − 69% of the uninjured side. In Group II there was consolidation in two cases of nonunity, Sudeck’s syndrome developed in two patients. Contractures and progressive arthrosis in the wrist were also observed. Recovery of Group I patients was 2.5 times quicker than in Group II and the functional results were much better in Group I throughout the whole course of treatment.

Conclusion. In comparison with conventional fixators, AO-plates (ORIF) help to perform anatomically accurate and stable osteosynthesis, which, in its turn, helps to promote early mobilization, to reduce the complications. All this leads to a fall in the disability rate and invalidity of patients.

The Acetabular Dysplasia creates serious technical problems for the insertion of acetabular socket. In first, cup must have a good primary stable fixation in a shallow acetabulum. In second, smaller cups are usually required in dysplasia hip, but small sockets must have thick polyethylene wall. And in third, cup design must ensuring easy reconstruction of the anterolateral bone defect. In our opinion, all these problems can be achieved by using of cementless acetabular Robert Mathys (RM) cups.

Materials and Methods

In the period from 1996 to 2000 168 patients with ace-tabular dysplasia were operated with titanium powder coated RM cups. The patients age was from 18 to 75 years old (average 43,5). In 77 patients with type I dysplasia (AAOS classification) a primary stable fixation of the acetabular component in a good position without of filling bone defect was achieved. In 53 patient with type II dysplasia stable fixation was supplemented by closing of a cup by filler bone grafts in a place of bone defect. In case of type III dysplasia (38 patients) with very shallow acetabulum and extensive bone defects initial stabilization was achieved by the press-fit one or two anchoring pegs and insertion cancellous screws. In type III dysplasia the massive bone transplant was fixed by additional screws. The features of a design of a cup allowed to stop on the small socket sizes without danger of use implant with critically thin polyethylene wall. It considerably improved a covering of a cup.

Results

In 166 patients (98,8 %) a good medium-term results (2–6 years) were obtained. The radiologic controls have shown that the prostheses underwent good osteointegration. 2 patients (1,2%) needed revision. Of them one patient had a infected complication, one other had an aceptic necrosis of acetabulum and secondary cup migration. In all other patients no osteolisis was observed. The good primary fixation of the RM cup decreased the risk of aseptic loosing of the autologous bone graft. The temporal partial (not more than 1/3) bone graft resorption was find in 33,9 % at the type II and 42,1 % at the type III dysplasia. After 2 years in all cases we observed improvement of the bone stock quality at the site of bone grafting.

Conclusions

The features of a design of RM cup allow to use implants of the small size. The application for cup fixation pegs and screws allows to receive its reliable primary stability even at expressed acetabular dysplasia. The good primary stability and ease of application of bone grafts allows to achieve with RM cup of an overall objective of operation - maximal restoration of anatomy and biomechanics of the dysplastic hip joint.