An unusual case of hip pain after total hip arthroplasty: A case report

Our goal is to draw attention to the inflammation of the iliopectineal bursa being a rare condition, which can cause lower limb swelling and anterior pain of the hip even years after total hip arthroplasty. A 67-year-old woman was admitted seven years after hip arthroplasty (cemented total endoprosthesis [TEP]) with swelling and feeling of excessive fullness of the lower extremity and with tolerable anterior hip pain. The physical examination and blood tests were non-specific for septic condition. Ultrasound showed a cystic mass in the inguinal region with a direct contact to the common femoral vein. Deep vein thrombosis was excluded. The single-photon emission computed tomography-computed tomography (SPECT-CT) was administered to decide the surgical plan, either making a bursa extirpation or making revision hip arthroplasty. The SPECT-CT excluded the possibility of aseptic loosening. Methylene blue was injected into the bursa intraoperatively which did not enter the strong pseudo-capsule of the joint and, therefore, we did not administer revision of the TEP, and the bursa was extirpated. Two weeks after the operation, the patient had no pain, was able to walk, and the swelling decreased. Four months after surgery, the pain and feeling of fullness disappeared, with minimal lower limb swelling. In conclusion, in case of increasing complaints of patients who left years behind without any problem following total hip arthroplasty, the pathogenic role of the iliopectineal bursa should be taken into account, after excluding more frequent causes such as aseptic loosening or periprosthetic joint infection. As long as we consider about a rare disease, we can find a solution to the patient’s complaint sooner.

TREATMENT OF BACK PAIN AFTER HIP ARTHROPLASTY, USING DEEP OSCILLATION

Objective: Deep Oscillation® is an electromechanical procedure with deep therapy that allow to create a pulsed electrostatic field between the hand applicator and the processing better tissue nutrition, enhanced cellular metabolism, faster healing. The purpose of this work is to assessment of the outcome of the treatment of spinal pain after hip arthroplasty using Deep osсillation Methods: The study included 85 patients between the ages of 40 and 75 who were referred to the Arena 2 Rehabilitation Center for post hip joint arthroplasty spine pain, including 57 women and 28 men. Patients physical modalities: complex rehabilitation programme including deep oscillation (DO - fibromyalgia programme) and kinesitherapy - active analytic exercises (including isometric exercises) and soft tissue techniques (post-isometric relaxation, stretching of the lumbar fascia, manual massage). Spinal condition was assessed before treatment after treatment using the Modified Oswestry Disability Index (ODI). Results: Mean value of points before treatment - 3.35+1.1, after treatment - 1.36+0.79. p<0.001 Oswestry Disability Index –67% and 27.2% respectively. Conclusion: After total endoprosthesis, there is a change in biomechanics and a shift in the center of gravity, which causes a change in the position of the spine and pain, so we definitely consider the spine examination and adequate rehabilitation and treatment in the post hip joint arthroplasty period. Involvement in the deep spine's treatment method reduces pain and improves the patient's quality of life, improve function and return-to-work status. Keywords: deep oscillation, hip arthroplasty, back pain.

Treatment of an extensive acetabular defect in a patient with aseptic instability of a total hip arthroplasty

The aim of the study is to demonstrate, using a clinical example, the possibility of treating a patient with a severe acetabular defect by performing a one-stage revision arthroplasty using an individual design. Materials and methods. A 45-year-old female patient was admitted with complaints of pain, limitation of movement in the right hip joint, and gait disturbance. From anamnesis at the age of 5 years, reconstructive operations of the hip joints were performed. In 1991, CITO performed primary total arthroplasty of the right hip joint with an endoprosthesis from ESKA Implants. In 1998, due to the instability of the acetabular component of the total endoprosthesis of the right hip joint, revision arthroplasty was performed, and the cup was placed with a cement fixation. In 2001, for left-sided dysplastic coxarthrosis, primary total arthroplasty of the left hip joint was performed. In 2012, due to the instability of the total endoprosthesis of the left hip joint, revision arthroplasty was performed using an ESI anti-protrusion ring (ENDOSERVICE) with a cement cup and a Zweimller-type femoral component; the femur defect was repaired using a fresh frozen cortical graft. In October 2019, instability of the total endoprosthesis of the right hip joint was revealed, for which revision endoprosthetics was performed using an individual acetabular component. Results. The HHS index before revision arthroplasty was 21 points, after 1 month after surgery 44 points, after 3 months after surgery 65, after 6 months 82. Quality of life was assessed according to the WOMAC scale: before surgery 73 points, after 1 month after surgery 54 points, after 3 months 31, after 6 months 15 points. At the time of the last consultation, the patient moves with a cane, lameness persists, associated with scar reconstruction and atrophy of the gluteal muscles. Conclusion. The use of individual structures allows to restore the support ability of the lower limb and the function of the hip joint in the case of an extensive defect of the pelvic bones of the pelvic discontinuity type.

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.

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.

INFLUENCE OF MICROBIAL CONTAMINATION OF BONE TISSUE ON ITS REGENERATOR POTENTIAL IN TOTAL ARTROPLASTY IN PATIENTS WITH RHEUMATOID ARTHRITIS

Relevance. Total arthroplasty of large joints in patients with RA in some cases lead to the development of infectious postoperative complications. Treatment of patients with systemic inflammatory pathology of the connective tissue - the process is long and has certain features. Among others, we were interested in the persistence of an autoimmune inflammatory process and associated pathologies, including osteopenia or osteoporosis. Therefore, research into the effects of microbial contamination on bone repair processes is relevant. Objective. To identify correlation relationships between bone regenerative potential and microbial factor in identical biopsies of surgical material from RA patients with primary total endoprosthesis (PTE) and to determine their effect on surgical results Materials and methods. The data of microbiological researches of operative material after 151 surgical interventions from 118 patients with RA about PTE of joints (337 samples), executed according to the operating methods, are analyzed. 280 bone marrow specimens were examined and 400 cultures of bone marrow stromal fibroblasts were grown from these patients. Results. Microorganisms in the culture from surgical material were isolated in 55.4% of RA patients with knee and hip joints PTE. The nature of the microflora was determined: these are staphylococci, streptococci, Corynebacterium spp., Anaerobic non-spore-forming, gram-negative microorganisms. There is a strong (almost functional) linear inverse correlation (coefficient r = ─ 0.98) between osteogenic activity of bone marrow stromal bone marrow cells and data from microbiological studies of surgical material in patients with RA. Contamination of bone spongiosis by microorganisms is likely to reduce the activity of colony-forming units of bone marrow fibroblasts by an average of 81.0% in the depression, by 53.0% in the femoral head and by 64.8% in the intervertebral area. Microbial contamination inhibits osteogenic potential by an average of 30.4%, or almost 2 times, revealing one of the mechanisms of occurrence of probable complications and directing measures for their prevention (changes in postoperative antibiotic therapy). Conclusion. The higher the contamination with microorganisms, the lower the osteogenic activity of bone marrow stromal cells of bones forming the knee and hip joints in RA patients.

THE QUALITY OF LIFE OF PATIENTS AFTER TOTAL ENDOPROSTHESIS REPLACEMENT OF HIP JOINT: PUBLICATIONS REVIEW

The main and generally accepted method of surgical treatment of arthrosis of hip joint is considered to be total arthroplasty. As a result, patient gets rid of pain, motor activity increases, more mobility and sociability are added. The surgical approaches (types of implants, operative approaches) and rehabilitation approaches (centers of specialized rehabilitation, outpatient rehabilitation clinics) are being improved. However, despite positive dynamics of improving quality of life, there is a group of patients of able-bodied age who have no satisfaction with surgery results.

Comparative analysis of the power indices of the lower extremity muscles in the patients after total endoprosthesis of the hip joint, depending on surgical access

Objective. To compare the power characteristics of the lower extremity muscles after endoprosthesis of a hip joint in application of anterior-lateral and posterior-lateral surgical accesses. Materials and methods. Biomechanical investigation in accordance to electrotensodynamometry in 120 patients preoperatively, in early (in 3 weeks) and late (in 4 mo) period after endoprosthesis of a hip joint. Operative intervention was performed, using anterior-lateral operative access in 60 patients, and applying posterior-lateral - in 60 patients as well. Conclusion. There was established, that restoration of necessary muscular balance after endoprosthesis of a hip joint is guaranteed by application of anterior-lateral and posterior-lateral access, but the terms of restoration of muscles of various groups are differed.

Estimation of impact of remodeling and microbial factors on the results of total endoprosthesis of a knee joint in patients, suffering rheumatoid arthritis

Objective. To estimate the impact of remodelling and microbial factors on the results of total endoprosthesis (ТЕP) of the knee joint in patients, suffering rheumatoid arthritis (RА). Маterials and methods. The results of microbiological investigations of operative specimen were compared with results of cloning of the stem stromal cells of the bone marrow. Міcrobiologically and microscopically there were studied 247 specimen of operative material, obtained during performance of primary TЕP of a knee joint in 64 patients, suffering RA. Results. As the investigations have shown, in 1 сm³ of spongious bone of distal femur there is in 1.4 times more a general quantity of cells, containing the nuclei, than in 1 сm3 of spongious bone of proximal tibiae (the difference is not statistically significant). In distal part of femur the quantity of a colony-creating units of fibroblasts (CCUF) in 1 сm³ is in a 9.8 times lower, than the CCUF quantity in 1 сm³ in proximal part of tibiae (the difference is statistically significant), аnd the efficacy of the CCUF cloning is accordingly more than in 2.1 times lower (difference is statistically nonsignificant). Conclusion. High level of contamination of predominantly gram-positive microorganisms of the bone operative material, obtained while primary TEP of a knee joint in 82.8% patients, suffering RA, have a strong (almost a functional one) linear adverse correlation (coefficient r = -0.98) with osteogenic аctivity of the stem stromal cells in the bone marrow, which form a knee joint, what necessitates overestimation of approaches, concerning preparation and performance of surgical intervention for guaranteeing the efficacy of orthopedic treatment and standards of the protocols.

The Efficiency of Substitutive Treatment with Moroctocog Alfa in Managing Hemostasis in Patients with Hemophilia A Without Inhibitors With Total Knee Arthroplasties

Hemophilia A is a hereditary coagulopathy caused by the deficiency of the coagulation factor VIII, whose main complication consists in disabling arthropathy. The most often affected joint is the one of the knee, due to which this article aims at presenting, on one hand, the role of continuous substitutive prophylactic treatment in preventing the onset of this complication and, on the other hand, the current view of orthopedic surgery in managing the above-mentioned complication. The continuous prophylactic treatment represents the best therapeutic conduct in preventing the onset of hemophilic arthropathy, yet this aspect is limited by two important factors: inappropriate medical support, dependence on the social and economic level of every country and inappropriate adherence of the patient to this thorough treatment, which represents a challenge for a life with no bleeding. Under the circumstances imposed by an insufficient substitutive treatment or by a deficient adherence of the patient to this, recurrent hemarthrosis shall lead to cartilage destruction and synovial hypertrophy (synovitis), which will impose, in time, total endoprosthesis in order to re-establish the motor function and to improve the life quality of the hemophilic patient. The surgery of the hemophilic patient is associated with an increased risk of hemorrhage and infection and it is practiced only with substitutive hematologic support. The key to the best results is the existence of a multidisciplinary experienced team, including an orthopedist, hematologist, physical therapist.