ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS

"Recommendations of the World Congress of Experts on Joint Endoprosthetics"

Staff of "Orthopaedics, Traumatology and Prosthetics" — Wed, 02 Apr 2025 00:00:00 +0300

In early 2025, the manual "Recommendations of the World Congress of Experts on Joint Endoprosthetics" was published, recommended by the Scientific and Publishing Council of the National Academy of Medical Sciences of Ukraine and designed for a wide range of users.

OSTEOSARCOPENIA: EPIDEMIOLOGY, RISK FACTORS AND MODERN MANAGEMENT STRATEGIES

Darina Kurylo, Nataliia Grygorieva — Wed, 02 Apr 2025 00:00:00 +0300

Osteosarcopenia is a combination of osteoporosis and sarcopenia that has been identified as a distinct geriatric syndrome, which has recently attracted increasing attention from the medical community. Unfortunately, to date, there are no unified criteria for defining this syndrome, which affects the determination of its epidemiology and prevention methods. The coexistence of osteoporosis and sarcopenia in an individual is associated with an increased risk of falls and fractures, reduced functional capabilities and quality of life, and a heightened risk of mortality; thus, it holds significant medical and social importance. The aim of this review was to analyze the current literature on osteosarcopenia, including its prevalence, pathogenesis, risk factors, and management. Methods. A review of literature sources was carried out in the electronic scientometric databases PubMed, Scopus, Web of Science and Google Scholar using the keywords: "osteoporosis", "sarcopenia", "osteosarcopenia", "sarcoporosis" for 2019-2024 with additional inclusion in the analysis of earlier publications which have a recognized scientific value. Both cohort and prospective studies, as well as meta-analyses and systematic reviews, were analyzed. The results of this work included clarifying terminology, determining the global prevalence of osteosarcopenia, and analyzing risk factors and key components of its pathogenesis, particularly in subjects with comorbidities (such as diabetes and obesity). Scientific studies on the most explored pharmacological and non-pharmacological approaches to treating osteosarcopenia were also reviewed, with a focus on methods that require further research to confirm their effectiveness. Conclusions. Given the prevalence of osteosarcopenia and the associated risks, further investigation, especially within the Ukrainian population, is highly relevant and necessitates new research to improve the management of this geriatric syndrome.

HEMOSTATIC SYSTEM DISORDERS IN PATIENTS WITH COXARTHROSIS OF III–IV STAGES AFTER TOTAL HIP ARTHROPLASTY (LITERATURE REVIEW)

Oleksandr Vysotskyi — Wed, 02 Apr 2025 00:00:00 +0300

Objective. Тo analyze the current state of diagnosis and prevention of hemostatic disorders in patients with Kellgren-Lawrence grade III-IV coxarthrosis after total hip arthroplasty based on s cientific l iterature. M ethods. A search was performed in PubMed, Web of Science, Google Scholar and Scopus. Using MeSH and keywords such as: "inflammatory markers", "coxarthrosis", "thromboembolism", "tranexamic acid", "anticoagulants", "inflammation", "fibrinolysis", "D-dimer", "arthroplasty", "hypercoagulability", "plasminogen". Results. An important issue in the prevention of thromboembolic complications during total hip arthroplasty is to determine the dynamics of fibrinolysis disorders. Thus, it was found that hip arthroplasty is characterized by an increase in inflammatory markers in the blood and hemostatic disorders. Conclusions. In clinical orthopedics, after hip arthroplasty in patients with coxarthrosis of III-IV stages, complications often occur in the form of hemostatic disorders, which are accompanied by the development of deep vein thrombosis of the extremities, in severe cases — pulmonary embolism. These complications are monitored based on the results of determining the markers of the hemostatic system, which are examined before and after surgery. It has been proven that there are many different factors that affect the development of hemostatic disorders in the body. The age factor, as elderly patients have their own metabolic characteristics and altered rheological properties of blood. Increased body weight, in particular, obesity, is also an important factor that cannot be ignored in clinical practice. To date, clear clinical and laboratory criteria for assessing the hemostatic system and a list of biochemical markers of connective tissue to monitor the condition of patients before and after joint replacement in the context of modern anticoagulant regimens remain to be defined.

THE EFFICIENCY OF SURGICAL TREATMENT AND REHABILITATION IN THE RECOVERY OF PATIENTS WITH A CETABULAR POSTERIOR WALL FRACTURES

Mykola Ankin, Viktoriia Ladyka, Oksana Glynyana, Mykola Barylovych — Wed, 02 Apr 2025 00:00:00 +0300

Fractures of the posterior wall of the acetabulum are one of the most difficult injuries to treat in Orthopedics and traumatology. The most common causes of this fracture are road traffic accidents, falls from heights, and injuries resulting from military actions. There is a high risk of post-traumatic arthritis at later stages and avascular necrosis, often leading to future disability. Objective. to assess the efficiency of surgical treatment and rehabilitation in patients with acetabular posterior wall fracture. Methods. The study was conducted at the Kyiv Regional Clinical Hospital and Kyiv City Clinical Hospital No. 8 from 2021 to 2023. A total of 44 patients aged 19 to 68 participated in the study. Treatment outcomes and rehabilitation measures were assessed using the Matta and Harris Hip Score scales. All patients underwent open reduction and internal fixation of the posterior wall of the acetabulum with plates and screws. The Kocher-Langenbeck surgical approach was used in all cases. Clinical and radiological results were analyzed at 3, 6, and 12 months in all patients. Results. The Harris Hip Score in the main group was (81.51 ± 4.03) points at 6 months and (87.09 ± 5.31) points at 12 months. In the control group, the scores were (75.43 ± 4.45) at 6 months and (84.01 ± 4.17) at 12 months (p < 0.01). Conclusions. Early closed reduction of hip joint dislocation and surgery with reconstruction of normal joint anatomy and stable fracture fixation is crucial for efficiency of surgical treatment.

Remote infrared thermography in the system of comprehensive diagnostics of the health of military personnel before surgical intervention

Wed, 02 Apr 2025 00:00:00 +0300

A complete and informative diagnosis of the general health of military personnel before surgical intervention is of great importance for its successful implementation. A simple and affordable diagnostic method of radiological diagnostics is the method of remote infrared thermography. Conducting a comprehensive thermographic examination of military personnel before surgical intervention allows for the treatment of those pathological conditions that were detected during the thermographic examination. Objective. To show the possibility and evaluate the diagnostic informativeness remote infrared thermography in the system of comprehensive diagnostic monitoring of the health of military personnel before surgical intervention; to obtain thermographic visualizations of detected pathological changes associated with participation in combat operations. Methods. The work used a domestic thermograph with a temperature sensitivity of 0.07 °C and a ThermaCAM thermograph E 300 FLIR SYSTEM. Observation and control of thermal fields were carried out in the ranges of 3÷5 μm and 8÷14 μm. The examination was carried out during inpatient and outpatient treatment. Results. Received thermographic visualizations detected pathologies: disorders functions breathing; thermal asymmetries zones projections lung because of COVID-19; complications after firearm injury — pneumothorax; zones hyperthermia temporal bones due to contusion; vascular pattern disorders in the thyroid gland; functional and chronic disorders organs gastrointestinal and urological pathologies; degenerativedystrophic musculoskeletal changes The oscillographic distributions of temperature patterns of the detected pathological conditions, which characterize the severity of traumatic and degenerative-dystrophic changes, were studied. Conclusions. In the presented work for the first time obtained and the results of a comprehensive thermographic health check-up military personnel after a long stay in the combat zone and before operational Remote infrared thermography, as one of the methods of radiological diagnostics, allows for a comprehensive examination of a significant number of military personnel in a short period of time and to identify pathological changes that require additional examination by narrowly specialized specialists.

ANKLE ARTHRODESIS AFTER COMBAT RELATED INJURIES

Wed, 02 Apr 2025 00:00:00 +0300

Combat related injuries of the ankle joint (AJ) are often accompanied by severe changes in the musculoskeletal system, which require arthrodesis of the damaged joints in the final stage of treatment. Objective. To analyze the results of AJ arthrodesis in patients after combat related injuries, to highlight aspects of the use of different fixation methods. Methods. AJ arthrodesis was performed in 21 patients with the consequences of severe combat related injuries of the posterior part of the foot. An intramedullary locked rod (18 patients), screws (2 patients) and an Ilizarov-type external fixation device (EFD) were used for fixation in one patient. The results were assessed no earlier than 6 months after the start of loading using the AOFAS (posterior part), SMFA (short musculoskeletal functional assessment) and EQ-5D-5L (mobility, self-care, usual activity, pain, anxiety, VAS) scales and questionnaires. Results: In the specified terms, the results were traced in 21 patients. A differential approach was used in choosing the method of fixation of the AJ. A significant increase in function was obtained according to the AOFAS, SMFA and EQ-5D-5L scales (p ˂ 0.001). Conclusions. AJ arthrodesis in patients with the consequences of severe combat related injuries allows to restore the resistance of the limb and is the final stage of treatment of these patients.

OUR EXPERIENCE IN USING MODIFIED BIOACTIVE CERAMICS FOR THE RECONSTRUCTION OF CRITICAL POST-TRAUMATIC BONE DEFECTS

Wed, 02 Apr 2025 00:00:00 +0300

According to statistical data from the National Military Medical Clinical Center for the period from February to May 2022, bone defects in gunshot fractures accounted for 76 % of cases, with defects exceeding 6 cm — classified as critical — found in 28 % of cases. Currently, the "gold standard" for reconstructing critical bone defects is the induced membrane technique, also known as the two-stage Masquelet technique. The most promising substitute for autologous bone is considered to be biphasic bioactive ceramics. In this study, we aimed to evaluate the feasibility of reconstructing critical bone defects resulting from combat trauma using a modified bioactive ceramic-autograft mixture during the second stage of the Masquelet technique, combined with additive manufacturing technologies. The study included a sample of 36 patients with critical bone defects who underwent reconstruction using the Masquelet technique. During the second stage, the defect was filled with a mixture of calcium phosphate ceramics (CPC) and autologous cancellous bone. We analyzed the treatment outcomes of patients with critical bone defects caused by combat-related injuries over the past 2.5 years who received treatment at the Dobrobut Medical Center. The evaluation criteria included pain levels, range of motion, axial load capacity, functional recovery (work capacity), and radiological signs of callus formation, deformities, graft migration, or remodeling. After 12 months of follow-up: Complete functional recovery (clinically and in range of motion) was achieved in 28 (78 %) patients. Partial functional recovery was observed in 7 (17 %) patients. Significant functional impairment requiring additional surgical interventions occurred in 1 (5 %) patient. Conclusions. Based on our experience, the use of a CPC-autograft mixture in the two-stage reconstruction of critical diaphyseal bone defects provides positive treatment outcomes in most clinical cases. The integration of 3D modeling and biodegradable materials enhances the range of possibilities for performing bone grafting procedures and simplifies technical challenges in reconstructive surgery.

THE EFFECT OF CO2 THERAPY AND ITS COMBINATIONS ON INFLAMMATORY ACTIVITY AND IMMUNE STATUS: AN EXPERIMENTAL STUDY

Viktor Shtroblia — Wed, 02 Apr 2025 00:00:00 +0300

Osteoarthritis (OA) is a chronic degenerative disease characterized by cartilage destruction, inflammation, and autoimmune processes. The limited effectiveness of current therapies has generated interest in alternative approaches, such as carboxytherapy, which possesses anti-inflammatory and regenerative properties. Objective. To evaluate the effects of carboxytherapy (CO₂) in mono- and combination therapy on a carrageenan-induced model of inflammation in rats by assessing leukocyte differential counts and integral indices. Methods. The study was conducted o n 56 white rats divided i nto 7 groups (n = 8): control (intact and carrageenan-induced), mono- and combination therapy with CO₂ in conjunction with diclofenac or chondroitin. Changes in the leukocyte differential counts and integral indices (NMR, NLR, LSI, LI, IIR) were evaluated. Results. CO₂ monotherapy (Group V) reduced the NMR (Neutrophil-to-Monocyte Ratio) by 25.4 % (15.60 ± 2.95 vs. 20.92 ± 8.89 in Group II, p < 0.001). The Leukocyte Index (LI) increased by 82.2 % (1.471 ± 0.155 vs. 1.791 ± 0.191, p = 0.001). The combination of CO₂ with diclofenac (Group VI) reduced NMR by 68.3 % (6.61 ± 2.72, p < 0.001) and increased LI by 103.1 % (3.637 ± 0.770, p < 0.001). CO₂ combined with chondroitin (Group VII) reduced the NLR (Neutrophil-to-Lymphocyte Ratio) by 48.6 % (0.290 ± 0.0938, p < 0.001) and increased LI by 121.7 % (3.847 ± 1.421, p < 0.001). In Groups VI and VII, there was a significant decrease in band neutrophils (by 79.2 % and 75.0 %, respectively) and an increase in lymphocytes (by 72.2 % and 70.9 %, p < 0.001). Conclusions. Carboxytherapy modulates the inflammatory response and enhances the immune response. The best results were observed with combined CO₂therapy with diclofenac or chondroitin, confirming their potential in reducing inflammation and stimulating regeneration.

ANALYSIS OF POSTOPERATIVE COMPLICATIONS IN THE SURGICAL TREATMENT OF PROXIMAL HUMERAL FRACTURES IN PATIENTS WITH DECREASED MINERAL BONE DENSITY

Vasyl Makarov, Mykola Korzh — Wed, 02 Apr 2025 00:00:00 +0300

Objective. To conduct a comparative retrospective analysis of the impact of postoperative complications on functional outcomes following different surgical treatment methods for proximal humeral fractures of AO/OTA types 11-B and 11-C in patients over 45 years old with decreased bone mineral density. Methods. The study analyzed the surgical treatment outcomes and postoperative complications in 102 patients aged (61.1 ± 8.1) years, who were divided into three groups based on the treatment method: (1) open reduction and internal fixation (ORIF) using a PHILOS plate (n = 50); (2) ORIF with a PHILOS plate combined with 3D-printed PLA implants (n = 44); (3) primary reverse total shoulder arthroplasty (RTSA) using a newly developed total reverse endoprosthesis (n = 8). Functional outcomes in patients with complications were assessed using the Constant-Murley Score at 3, 6, and 12 months postoperatively and analyzed based on individual preoperative parameters and treatment methods. Results. A total of 30 postoperative complications were recorded, the most common being superficial infection (7.8 % of the total population), secondary displacement (6.9 %), varus malalignment of fragments (6.9 %), and avascular necrosis of the humeral head (3.9 %). The highest number of complications was observed in Group (1), with 19 patients affected, accounting for 38 % . For all complications except avascular necrosis, a significant improvement in functional outcomes was observed between 3 and 12 months postoperatively. The mean Constant-Murley Score in patients with complications at 12 months postoperatively was (78.7 ± 8.5). Conclusions A retrospective analysis of postoperative complications following different surgical treatment methods established that, compared to other options, reverse total shoulder arthroplasty (RTSA) is a modern and optimal surgical treatment option for proximal humeral fractures of AO/OTA types 11-B or 11-C in the context of severe bone mineral density reduction, particularly in elderly patients.

THE IMPACT OF PREOPERATIVE VOLUME OVERLOAD ON HEMODYNAMIC PARAMETERS DURING SHOULDER ARTHROSCOPY

Kseniia Lyzogub, Mykola Lyzogub — Wed, 02 Apr 2025 00:00:00 +0300

Objective. To investigate the influence of preoperative volemic loading on changes in hemodynamic parameters due to positioning of anesthetized patients in the beach chair position. Methods. A prospective randomized single-center study included 140 patients. Group I (n = 70) — patients who underwent preoperative loading in a volume of 12 ml/kg before changing the body position. Group II (n = 70) — patients who did not undergo preoperative loading. After induction with propofol/fentanyl in standard doses and orotracheal intubation, the patient was transferred from the supine position to the BCP. Non-invasive systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate were determined using a Mediana YM6000 monitor. The first measurement of SBP, DBP, and MAP was performed immediately after positioning the patient supine, the second after induction, the third 5 minutes after positioning in the NSP, and subsequently blood pressure measurements were performed every 5 minutes, heart rate, and SpO₂ continuously. In the postoperative period, the following criteria were evaluated: frequency of nausea/vomiting, frequency of orthostatic collapse within 48 hours, average heart rate within 6 hours. Results. Induction of general anesthesia caused comparable changes in hemodynamics in patients of the studied groups without significant differences between groups. When changing the body position in the BCP, hemodynamic changes had significant differences between groups. Only 7.1 % of the subjects in group I had nausea and vomiting in the early postoperative period, while in group II 21.4 % of patients had nausea and vomiting. The development of tachycardia was noted during the first 6 hours after surgery in patients in group II (95.0 ± 5.8), compared with group I (70.3 ± 6.5) (p < 0.001). The development of orthostatic collapse was observed more often in patients in group II and amounted to 14.3 % vs. 10.0 % of the subjects in group I. Conclusions. Preoperative infusion loading does not significantly affect hemodynamic reactions that occur during induction of general anesthesia in young patients ASA I-II. Preoperative infusion loading during operations in a BCP significantly reduces the number of early postoperative complications: postoperative nausea and vomiting, orthostatic collapse and the development of tachycardia.

UKRAINIAN-LANGUAGE VALIDATED SCALES FORGOTTEN JOINT SCORE-12 FOR PATIENTS AFTER HIP AND KNEE ARTHROPLASTY

Wed, 02 Apr 2025 00:00:00 +0300

The Forgotten Joint Score-12 (FJS-12) is an important tool for assessing the effectiveness of treatment of patients after large joint arthroplasty. Its main advantage is its sensitivity to the patient's subjective perception of the artificial joint, which makes it extremely useful for assessing the level of comfort after surgery. Objective. To perform an official translation of the Forgotten Joint Score-12 scale into Ukrainian, to conduct its adaptation and validation among patients who have undergone knee or hip arthroplasty. The translation was carried out within the framework of official cooperation with Forgotten Joint Scores (BGGK GmbH, Switzerland) in accordance with international standards Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures. Results. The pilot testing was conducted among 20 patients and was aimed at identifying the clarity of the questions, ease of completion and time required to complete the survey. That is why this scale allows to assess the degree of awareness of the presence of a joint implant in everyday life, is an important addition to existing methods of studying the results of treatment. Conclusions. Due to its unique approach, the FJS-12 allows for a more accurate assessment of the results of arthroplasty, which contributes to the improvement of surgical techniques, optimisation of rehabilitation programmes and improvement of the level of medical care. Its Ukrainian-language version is now available for use in clinical practice and scientific research in our country, which will contribute to a more objective assessment of the effectiveness of treatment of patients after total arthroplasty. This also opens up new opportunities for international cooperation, as it allows Ukrainian researchers to use unified assessment methods and compare their results with those of their colleagues.

QUALITY CRITERIA FOR MINIMALLY MANIPULATED BIOTECHNOLOGICAL PRODUCTS BASED ON AUTOLOGOUS BONE MARROW ASPIRATE FOR USE IN TRAUMATOLOGY AND ORTHOPEDICS

Wed, 02 Apr 2025 00:00:00 +0300

Autologous biotechnological products based on bone marrow (BM) are a source of stem cells, in particular, hematopoietic and multipotent mesenchymal stromal cells, and act as one of the alternative therapeutic agents that can slow cartilage degeneration, improve its repair and, ultimately, prevent joint replacement. Objective. To develop quality and safety criteria of minimally manipulated biotechnological products from autologous bone marrow for use in patients with pathology of the musculoskeletal system. Methods. The material for the development of quality and safety criteria for the manufacture and use of biotechnological products from autologous red bone marrow aspirate was 85 patients with osteoarthritis and aseptic necrosis of the hip and knee joints, who used biotechnological products made from it. Cell counts in the myelogram and CFU-analysis of MMSCBM were performed in all patients. Results. As a result of the development of quality and safety criteria for biotechnological products from BM aspirate, 3 types of it were established: 1 — polymorphic (with the presence of progenitor cells of all types within the normal range), 2 — moderately cellular (with the presence of all types of progenitor cells, but some of them below the norm), 3 — hypocellular (with the presence of most types of progenitor cells, some of them below the norm). Functional quality criteria of biotechnological products from BM aspirate were developed on the basis of CFU-analysis and calculation of seeding efficiency coefficient (KEP) of MMSK-BM. Conclusions. Quality and safety criteria of biotechnological products based on autologous bone marrow aspirate based on the results of myelograms and CFU analysis have been established. According to the results of myelograms, type 1 BM aspirate was evaluated as excellent for the further manufacture of a biotechnological product, type 2 — good, type 3 — satisfactory. According to the results of the KUOf analysis, the KEP indicator ˂ 0.001 % was evaluated as unsatisfactory, the KEP indicator within the range of 0.001–0.003 % — satisfactory, the KEP indicator ˃ 0.003 % — good. The KEP ˂ 0.001 % — unsuitable for use.

FEATURES OF DEFORMATION OF THE «DEBRIS – EXTERNAL CORE APPARATUS» MODEL IN THE CASE OF USING STRUCTURES WITH DIFFERENT STRUCTURAL GEOMETRY

Olexii Popsuishapka, Igor Subbota — Wed, 02 Apr 2025 00:00:00 +0300

Objective. To study the linear and angular displacements of the "fragments" during their connection with an external rod apparatus manufactured by HB ORTHO (Ukraine) or Orthofix (USA) under different variants of the geometry of the "fragments – apparatus" structure in order to clarify the mechanical principles of its rational construction. Methods. The model was rigidly fixed at one end in a horizontal position, and a transverse force was alternately applied to the opposite end using weights of 1, 2, 3, 4, 5 kg. The experiment involved the study of the magnitude and nature of the displacement of the fragments depending on the following parameters of the rods: the number of rods in the fragment (2 or 3); diameter (5, 6 mm); length of the rod section from the bone to the support (100, 50 mm); length of the bone section between the extreme rods (150, 100 mm); the presence of a multi-plane arrangement of the rods and, in particular, when they formed a 45° angle between them, the number of external supports: one or two, located in parallel or side by side. Results. The first most important parameter that influenced the amount of displacement of the distal "fragment" was the distance from the bone to the support. In the case of a distance of 50 mm, the amount of displacement of the fragment is 2–4 times less than in the case of 100 mm. The second parameter that influenced the displacement of the fragments was the length of the bone section between the extreme rods screwed into the fragment. If it is reduced by 30 %, the displacement increases by 64% and almost does not depend on whether 2 or 3rods were used. It is possible to significantly reduce the displacement of the distal fragment (at least twofold) by inserting rods in different planes, in particular, by positioning the rod so that in the proximal fragment near the fracture in a plane that is 45° to the frontal plane. With a gradual transverse load, the deformation of the structure at the initial stages (1, 2, 3 kg) is elastic in nature and with an increase (up to 4–5 kg), residual deformation occurs due to: movement of the clamp on the cylindrical support; plastic deformation of the rods, which is inherent in HB ORTHO devices (Ukraine).

MATHEMATICAL MODELING OF THE MUSCLES RESPONSIBLE FOR SHOULDER JOINT FLEXION IN UPPER OBSTETRIC PARALYSIS

Olena Karpinska, Anastasiia Hrytsenko — Wed, 02 Apr 2025 00:00:00 +0300

Objective. To determine the degree of change in muscle length and torque of the shoulder joint during flexion in conditions of the pathological position of the upper limb in Erb-Duchen syndrome. Methods. The analysis of the change in muscle length and torque of the shoulder joint was performed at flexion within 50°– 60°. In the Erb syndrome clinic, the torque value of the joint is reduced due to weakness or paralysis of the muscles that provide stability and mobility of the shoulder joint. Verification of the appearance of the model was carried out according to the 3D-model obtained from the CT scan of the patient. Results. After analyzing the work of the muscles responsible for the flexion of the shoulder joint, it was determined that a decrease in muscle strength leads to a decrease in the moment of force acting on the joint, a change in the length of the force lever affects the moment of force, a change in the angle between the force and the arm of the force leads to a decrease in the muscle's efficiency. Internal rotation of the humerus reduces the length of the muscle, which is demonstrated in the models. When lifting the arm with a load, the muscle shortens and its length decreases accordingly. Other muscles not represented in the model do not contribute to the generation of torque of the shoulder joint due to their lack of direct connection to the humerus, but they are responsible for the movement of the scapula and clavicle. A decrease in their strength, a change in the direction of the force vector leads to significant changes in the ratio of the anatomical structures of the shoulder girdle with high individual variability. Conclusions. A change in the direction of the force vector of a muscle and its length during bending lead to changes in motor activity: a decrease in the moment of the joint leads to a limitation of the amplitude of movements in the joint, the balance between different muscles acting on the joint is disturbed, it can lead to its instability and deformates. Biomechanical changes limit the functionality of the joint and cause pain syndrome. The identified biomechanical changes indicatethe need to correct the specified pathological conditions.

USE OF INDIVIDUAL INSTRUMENT FOR HIGH TIBIAL ALGUS OSTEOTOMY IN VARUS GONARTHROSIS

Maxim Golovakha, Stanislav Bondarenko, Radek Hart, Weniamin Orljanski — Wed, 02 Apr 2025 00:00:00 +0300

The work purpose was to present a new method of preoperative planning of high valgus tibial osteotomy with an individual instrument. Methods. Computed tomography (CT) of the lower extremities of a patient with stage II varus gonarthrosis was used. Bone segmentation from surrounding tissues, modeling of the lower extremities, correction of the tibia axis, and construction of individual blocks for resection were performed. The individual instrument is a block for performing osteotomy with depth indication and a hole for the upper middle screw of the T-shaped plate and two individual wedges for opening the osteotomy to the marks applied to them. The surgical intervention was performed with fluoroscopy control after knee arthroscopy. Partial removal of the medial meniscus and microfracture of the cartilage defect of the medial femoral condyle were performed simultaneously. Results. The planned correction of the tibia was accurately reproduced, which was confirmed by CT after surgery. In the postoperative period, there were no complications with wound healing, loading of the limb was started after 3 weeks, walking with a cane after 6, and without additional support after 10. X-rays were performed after 6, 12 weeks and 6, 12 months after the operation. A year later, the full range of motion and symmetrical walking were restored. The individual instrument allowed for quick and accurate placement of the plate, and wedges for opening the osteotomy helped to correctly reproduce the correction and hold it during osteosynthesis. Conclusion. The use of the proposed individual instrument for high valgus tibial osteotomy was convenient, simplified some stages of the surgical intervention, and ensured accurate planned correction of the angular deformity.