Treatment of aseptic osteonecrosis of the talus. A draft of clinical guidelines

Clinical guidelines are an algorithm adapted for use in our country, based on the works systematized by the level of evidence, reflecting current approaches to the diagnosis and treatment of aseptic bone necrosis (osteonecrosis) of various localizations. Purpose of the study. Creation of an algorithm for diagnosis and treatment of osteonecrosis based on the assessment of the evidence level of literature data.

Material and methods. The Guidelines are a systematized algorithm based on the level of evidence for the management of patients with osteonecrosis, reflecting current approaches to diagnosis, treatment and rehabilitation, which are based on literature data and the authors' own experience. Electronic databases of Medline, Embase, Web of Science, and Cochrane Library platforms were searched for related sources. Preference was given to the works with high levels of evidence. References to information sources are given in the order of their appearance in the text. The search depth was 50 years due to the availability of systematic literature reviews in the framework of previous international clinical guidelines. When specific medical procedures related to the diagnosis, conservative or surgical treatment of osteonecrosis were included in the clinical recommendations, their level of evidence was reliability, the appropriateness of their use, taking into account the unified scale for assessing the quality of evidence and the strength of the recommendations for application of medical technologies GRADE.

Results. The Guidelines reflect aspects of clinical, instrumental and laboratory examination of patients with osteonecrosis, treatment options depending on the location of the process and disease stage.

Conclusion. Clinical recommendations on the medical assistance to patients with aseptic osteonecrosis have been compiled according to the requirements imposed on clinical recommendations developed by medical professional non-profit institutions.

1. Malizos K.N., Karantanas A.H., Varitimidis S.E., Dailiana Z.H., Bargiotas K., Maris T. Osteonecrosis of the femoral head: etiology, imaging and treatment. Eur. J. Radiol., 2007, vol. 63, no. 1, pp. 16-28. DOI: 10.1016/j.ejrad.2007.03.019.

2. Ilinykh E.V., Barskova V.G., Lidov P.I., Nasonov E.L. Osteonekroz. Chast 1. Faktory riska i patogenez [Osteonecrosis. Part 1. Risk factors and pathogenesis]. Sovremennaia Revmatologiia, 2013, no. 1, pp. 17-24. (in Russian)

3. Mankin H.J. Nontraumatic necrosis of bone (osteonecrosis). N. Engl. J. Med., 1992, vol. 326, no. 22, pp. 1473-1479. DOI: 10.1056/NEJM199205283262206.

4. Canale S.T., Belding R.H. Osteochondral lesions of the talus. J. Bone Joint Surg. Am., 1980, vol. 62, no. 1, pp. 97-102.

5. Yamamoto T., Bullough P.G. Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. J. Bone Joint Surg. Am., 2000, vol. 82, no. 6, pp. 858-866. DOI: 10.2106/00004623-200006000-00013.

6. Varoga D., Drescher W., Pufe M., Groth G., Pufe T. Differential expression of vascular endothelial growth factor in glucocorticoid-related osteonecrosis of the femoral head. Clin. Orthop. Relat. Res., 2009, vol. 467, no. 12, pp. 3273-3282. DOI: 10.1007/s11999-009-1076-3.

7. Mont M.A., Jones L.C, Hungerford D.S. Nontraumatic osteonecrosis of the femoral head: ten years later. J. Bone Joint Surg. Am., 2006, vol. 88, no. 5, pp. 1117-1132. DOI: 10.2106/JBJS.E.01041.

8. Aya-ay J., Athavale S., Morgan-Bagley S., Bian H., Bauss F., Kim H.K. Retention, distribution, and effects of intraosseously administered ibandronate in the infarcted femoral head. J. Bone Miner. Res., 2007, vol. 22, no. 1, pp. 93-100. DOI: 10.1359/jbmr.060817.

9. Bowers J.R., Dailiana Z.H., McCarthy E.F., Urbaniak J.R. Drug therapy increases bone density in osteonecrosis of the femoral head in canines. J. Surg. Orthop. Adv., 2004, vol. 13, no. 4, pp. 210-216.

10. Kim H.K., Morgan-Bagley S., Kostenuik P. RANKL inhibition: a novel strategy to decrease femoral head deformity after ischemic osteonecrosis. J. Bone Miner. Res., 2006, vol. 21, no 12, pp. 1941-1954. DOI: 10.1359/jbmr.060905.

11. Yang J., Wang L., Xu Y., Fan K., Wang J. An experimental osteonecrosis of femoral head induced by a combination of a single low-dose lipopolysaccharide and methylprednisone. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi, 2008, vol. 22, no. 3, pp. 271-275. (in Chinese)

12. Steffen R.T., Athanasou N.A., Gill H.S., Murray D.W. Avascular necrosis associated with fracture of the femoral neck after hip resurfacing: histological assessment of femoral bone from retrieval specimens. J. Bone Joint Surg. Br., 2010, vol. 92, no. 6, pp. 787-793. DOI: 10.1302/0301-620X.92B6.23377.

13. Smirnov A.V. Rentgenologicheskaia diagnostika porazheniia tazobedrennykh sustavov pri revmaticheskikh zabolevaniiakh [X-ray diagnosis of the hip involvement in rheumatic diseases]. Consilium Medicum, 2003, vol. 5, no. 8, pp. 442-446. (in Russian)

14. Hungerford D.S., Lennox D.W. The importance of increased intraosseous pressure in the development of osteonecrosis of the femoral head: implications for treatment. Orthop. Clin. North Am., 1985, vol. 16, no. 4, pp. 635-654.

15. Cooper C., Steinbuch M., Stevenson R., Miday R., Watts N.B. The epidemiology of osteonecrosis: findings from the GPRD and THIN databases in the UK. Osteoporos. Int., 2010, vol. 21, no. 4, pp. 569-577. DOI: 10.1007/s00198-009-1003-1.

16. Ito H., Matsuno T., Minami A. Relationship between bone marrow edema and development of symptoms in patients with osteonecrosis of the femoral head. AJR Am. J. Roentgenol., 2006, vol. 186, no. 6, pp. 1761-1770. DOI: 10.2214/AJR.05.0086.

17. Anderson I.F., Crichton K.J., Grattan-Smith T., Cooper R.A., Brazier D. Osteochondral fractures of the dome of the talus. J. Bone Joint Surg. Am., 1989, vol. 71, no. 8, pp. 1143-1152.

18. Hepple S., Winson I.G., Glew D. Osteochondral lesions of the talus: a revised classification. Foot Ankle Int., 1999, vol. 20, no. 12, pp. 789-793. DOI: 10.1177/107110079902001206.

19. Pritsch M., Horoshovski H., Farine I. Arthroscopic treatment of osteochondral lesions of the talus. J. Bone Joint Surg. Am., 1986, vol. 68, no. 6, pp. 862-865.

20. Mintz D.N., Tashjian G.S., Connell D.A., Deland J.T., O'Malley M., Potter H.G. Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation. Arthroscopy, 2003, vol. 19, no. 4, pp. 353-359. DOI: 10.1053/jars.2003.50041.

21. Grieser T. Atraumatische und aseptische Osteonekrose großer Gelenke [Atraumatic and aseptic osteonecrosis of large joints]. Radiologe, 2019, vol. 59, no. 7, pp. 647-662. (in German) DOI: 10.1007/s00117-019-0560-3.

22. Gardeniers J.V.M. Report of the Committee of Staging and Nomenclature. ARCO News Letter, 1993, vol. 5, no. 2, pp. 79-82.

23. Singer F.R., Eyre D.R. Using biochemical markers of bone turnover in clinical practice. Cleve. Clin. J. Med., 2008, vol. 75, no. 10, pp. 739-750. DOI: 10.3949/ccjm.75.10.739.

24. Epstein S. Serum and urinary markers of bone remodeling: assessment of bone turnover. Endocr. Rev., 1988, vol. 9, no. 4, pp. 437-449. DOI: 10.1210/edrv-9-4- 437.

25. Pivec R., Johnson A.J., Harwin S.F., Mont M.A. Differentiation, Diagnosis, and Treatment of Osteoarthritis, Osteonecrosis, and Rapidly Progressive Osteoarthritis. Orthopedics, 2013, vol. 36, no. 2, pp. 118-125. DOI: 10.3928/01477447-20130122-04.

26. Ragab Y., Emad Y., Abou-Zeid A. Bone marrow edema syndromes of the hip: MRI features in different hip disorders. Clin. Rheumatol., 2008, vol. 27, no. 4, pp. 475-482. DOI: 10.1007/s10067-007-0731-x.

27. Narváez J., Narváez J.A., Rodriguez-Moreno J., Roig-Escofet D. Osteonecrosis of the knee: differences among idiopathic and secondary types. Rheumatology (Oxford), 2000, vol. 39, no. 9, pp. 982-989. DOI: 10.1093/rheumatology/39.9.982.

28. Sun W., Li Z.R., Yang Y.R., Shi Z.C., Wang B., Liu B., Shi S. Experimental study on phase-contrast imaging with synchrotron hard X-ray for repairing osteonecrosis of the femoral head. Orthopedics, 2011, vol. 34, no. 9, pp. e530-e534. DOI: 10.3928/01477447-20110714-07.

29. Cegarra Navarro M.F., Martínez Fernández M., Blanco Barrio A., Lloret Estañ F. Resonancia magnética de la osteonecrosis espontánea de la rodilla: ¿existe un proceso agudo o crónico predisponente? [Can MRI determine whether acute or chronic processes predisposing conditions are present in spontaneous osteonecrosis of the knee?]. Radiologia, 2010, vol. 52, no. 3, pp. 234-240. (in Spanish) DOI: 10.1016/j.rx.2009.12.013.

30. Patel R., Eltgroth M., Souza R., Zhang C.A., Majumdar S., Link T.M., Motamedi D. Loaded versus unloaded magnetic resonance imaging (MRI) of the knee: Effect on meniscus extrusion in healthy volunteers and patients with osteoarthritis. Eur. J. Radiol. Open, 2016, vol. 3, pp. 100-107. DOI: 10.1016/j.ejro.2016.05.002.

31. Stevens K., Tao C., Lee S.U., Salem N., Vandevenne J., Cheng C., Neumann G., Valentin-Opran A., Lang P. Subchondral fractures in osteonecrosis of the femoral head: comparison of radiography, CT, and MR imaging. AJR Am. J. Roentgenol., 2003, vol. 180, no. 2, pp. 363-368. DOI: 10.2214/ajr.180.2.1800363.

32. McCollough C.H., Leng S., Yu L., Fletcher J.G. Dual- and multi-energy CT: principles, technical approaches, and clinical applications. Radiology, 2015, vol. 276, no. 3, pp. 637-653. DOI: 10.1148/radiol.2015142631.

33. Ryu K.N., Jin W., Park J.S. Radiography, MRI, CT, bone scan and PET-CT. In: Koo K.H., Mont M.A., Jones L.C., eds. Osteonecrosis. Heidelberg, Springer, 2014, pp. 179-195. DOI: 10.1007/978-3-642-35767-1_23.

34. Narváez J.A., Narváez J., De Lama E., Sánchez A. Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture. Eur. Radiol., 2003, vol. 13, no. 8, pp. 1843-1848. DOI: 10.1007/s00330-002-1775-6.

35. Horikawa A., Miyakoshi N., Shimada Y., Kodama H. Spontaneous Osteonecrosis of the Knee: A Retrospective Analysis by Using MRI and DEXA. Open Orthop. J., 2016, vol. 10, pp. 532-538. DOI:10.2174/1874325001610010532.

36. Gross C.E., Haughom B., Chahal J., Holmes G.B. Jr. Treatments for avascular necrosis of the talus: a systematic review. Foot Ankle Spec., 2014, vol. 7, no. 5, pp. 387-397. DOI: 10.1177/1938640014521831.

37. Bergmann G., Graichen F., Rohlmann A. Hip joint forces during walking and running, measurement in two patients. J. Biomech., 1993, vol. 26, no. 8, pp. 969-990. DOI: 10.1016/0021-9290(93)90058-m.

38. Reginster J.Y., Malmstrom K., Mehta A., Bergman G., Ko A.T., Curtis S.P., Reicin A.S. Evaluation of the efficacy and safety of etoricoxib compared with naproxen in two, 138-week randomised studies of patients with osteoarthritis. Ann. Rheum. Dis., 2007, vol. 66, no. 7, pp. 945-951. DOI: 10.1136/ard.2006.059162.

39. Bruyère O., Honvo G., Veronese N., Arden N.K., Branco J., Curtis E.M., Al-Daghri N.M., Herrero-Beaumont G., Martel-Pelletier J., Pelletier J.P., Rannou F., Rizzoli R., Roth R., Uebelhart D., Cooper C., Reginster J.Y. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin. Arthritis Rheum., 2019, vol. 9, no. 3, pp. 337-350. DOI: 10.1016/j.semarthrit.2019.04.008.

40. Patrignani P., Tacconelli S., Bruno A., Sostres C., Lanas A. Managing the adverse effects of nonsteroidal anti-inflammatory drugs. Expert Rev. Clin. Pharmacol., 2011, vol. 4, no. 5, pp. 605-621. DOI: 10.1586/ecp.11.36.

41. Weinstein R.S. Glucocorticoid-induced osteonecrosis. Endocrine, 2012, vol. 41, no. 2, pp. 183-190. DOI: 10.1007/s12020-011-9580-0.

42. Shumskii A.A. Diagnostika i farmakologicheskaia terapiia rannikh stadii asepticheskogo nekroza golovki bedrennoi kosti. Avtoref. dis. … kand. med. nauk [Diagnosis and pharmacological therapy of the early stages of femoral head aseptic necrosis. Cand. med. sci. diss. abstr.]. M., 2015, 24 p. (in Russian)

43. Mironov S.P., Rodionova S.S., Shumskii A.A., comp. Farmakologicheskaia terapiia rannikh stadii asepticheskogo nekroza golovki bedrennoi kosti: med. tekhnologiia [Pharmacological therapy of the early stages of femoral head aseptic necrosis: medical technology]. FSI CPITO of RosMedTechnologies. M., 2011, 11 p. (in Russian)

44. Varenna M., Binelli L., Casari S., Zucchi F., Sinigaglia L. Effects of dietary calcium intake on body weight and prevalence of osteoporosis in early postmenopausal women. Am. J. Clin. Nutr., 2007, vol. 86, no. 3, pp. 639-644. DOI: 10.1093/ajcn/86.3.639.

45. Buclin T., Jacquet A.F., Burckhardt P. Absorption intestinale de gluconate de calcium et de complexe osséino-minéral: évaluation par des dosages conventionnels [Intestinal absorption of calcium gluconate and oseine-mineral complex: an evaluation by conventional analyses]. Schweiz. Med. Wochenschr., 1986, vol. 116, no. 50, pp. 1780-1783. (in French)

46. Wacker M., Holick M.F. Sunlight and Vitamin D: A global perspective for health. Dermatoendocrinol., 2013, vol. 5, no. 1, pp. 51-108. DOI: 10.4161/derm.24494.

47. Bischoff-Ferrari H.A., Dawson-Hughes B., Baron J.A., Burckhardt P., Li R., Spiegelman D., Specker B., Orav J.E., Wong J.B., Staehelin H.B., O'Reilly E., Kiel D.P., Willett W.C. Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am. J. Clin. Nutr., 2007, vol. 86, no. 6, pp. 1780-1790. DOI: 10.1093/ajcn/86.5.1780.

48. Doetsch A.M., Faber J., Lynnerup N., Wätjen I., Bliddal H., Danneskiold-Samsøe B. The effect of calcium and vitamin D3 supplementation on the healing of the proximal humerus fracture: a randomized placebo-controlled study. Calcif. Tissue Int., 2004, vol. 75, no. 3, pp. 183-188. DOI: 10.1007/s00223-004-0167-0.

49. Melnichenko G.A., Belaia Zh.E., Rozhinskaia L.Ia., Toroptsova N.V., Alekseeva L.I., Biriukova E.V., Grebennikova T.A., Dzeranova L.K., Dreval A.V., Zagorodnii N.V., Ilin A.V., Kriukova I.V., Lesniak O.M., Mamedova E.O., Nikitinskaia O.A., Pigarova E.A., Radionova S.S., Skripnikova I.A., Tarbaeva N.V., Farba L.Ia., Tsoriev T.T., Chernova T.O., Iureneva S.V., Iakushevskaia O.V., Dedov I.I. Federalnye Klinicheskie Rekomendatsii po diagnostike, lecheniiu i profilaktike osteoporoza [Federal Clinical Recommendations on osteoporosis diagnosis, treatment and prevention]. Problemy Endokrinologii, 2017, vol. 63, no. 6, pp. 392-426. (in Russian) DOI: 10.14341/probl2017636392-426.

50. Ramachandran M., Ward K., Brown R.R., Munns C.F., Cowell C.T., Little D.G. Intravenous Bisphosphonate Therapy for Traumatic Osteonecrosis of the Femoral Head in Adolescents. J. Bone Joint Surg. Am., 2007, vol. 89, no. 8, pp. 1727-1734. DOI: 10.2106/JBJS.F.00964.

51. Chen C.H., Chang J.K., Lai K.A., Hou S.M., Chang C.H., Wang G.J. Alendronate in the prevention of collapse of the femoral head in nontraumatic osteonecrosis: a two-year multicenter, prospective, randomized, double-blind, placebo-controlled study. Arthritis Rheum., 2012, vol. 64, no. 5, pp. 1572-1578. DOI: 10.1002/art.33498.

52. Rolvien T., Schmidt T., Butscheidt S., Amling M., Barvencik F. Denosumab is effective in the treatment of bone marrow oedema syndrome. Injury, 2017, vol. 48, no. 4, pp. 874-879. DOI: 10.1016/j.injury.2017.02.020.

53. Zywiel M.G., McGrath M.S., Seyler T.M., Marker D.R., Bonutti P.M., Mont M.A. Osteonecrosis of the knee: a review of three disorders. Orthop. Clin. North Am., 2009, vol. 40, no. 2, pp. 193-211. DOI: 10.1016/j.ocl.2008.10.010.

54. Karim A.R., Cherian J.J., Jauregui J.J., Pierce T., Mont M.A. Osteonecrosis of the knee: review. Ann. Transl. Med., 2015, vol. 3, no. 1, pp. 6. DOI: 10.3978/j.issn.2305-5839.2014.11.13.

55. Agarwala S., Vijayvargiya M. Single Dose Therapy of Zoledronic Acid for the Treatment of Transient Osteoporosis of Hip. Ann. Rehabil. Med., 2019, vol. 43, no. 3, pp. 314-320. DOI: 10.5535/arm.2019.43.3.314.

56. Agarwala S., Vijayvargiya M. Bisphosphonate combination therapy for non-femoral avascular necrosis. J. Orthop. Surg. Res., 2019, vol. 14, no. 1, pp. 112. DOI: 10.1186/s13018-019-1152-7.

57. Cross M., Macara M., Little E., Chan M., Little D., Buchbinder R., Hill C.L., Duncan E., Inderjeeth C., Major G., Sambrook P., March L. Efficacy of zoledronate in treating osteonecrosis of femoral head: a randomized controlled trial. Osteoarthritis and Cartilage. Abstracts, 2018, vol. 26, no. Suppl. 1, pp. S309-S310. DOI: 10.1016/j.joca.2018.02.622.

58. Arai R., Takahashi D., Inoue M., Irie T., Asano T., Konno T., Terkawi M.A., Onodera T., Kondo E., Iwasaki N. Efficacy of teriparatide in the treatment of non-traumatic osteonecrosis of the femoral head: a retrospective comparative study with alendronate. BMC Musculoskelet. Disord., 2017, vol. 18, no. 1, pp. 24. DOI: 10.1186/s12891-016-1379-y.

59. Rodionova S.S., Shumskii A.A. Novyi podkhod k lecheniiu rannikh stadii asepticheskogo nekroza golovki bedrennoi kosti [A new approach to treating early stages of aseptic necrosis of the femoral head]. Tretii Rossiiskii Kongress po osteoporozu: sbornik tezisov [Proceedings of the 3rd Russian Congress on Osteoporosis]. Ekaterinburg, 2008, p. 54. (in Russian)

60. Sung P.H., Yang Y.H., Chiang H.J., Chiang J.Y., Chen C.J., Yip H.K., Lee M.S. Cardiovascular and Cerebrovascular Events Are Associated With Nontraumatic Osteonecrosis of the Femoral Head. Clin. Orthop. Relat. Res., 2018, vol. 476, no. 4, pp. 865-874. DOI: 10.1007/s11999.0000000000000161.

61. Claßen T., Becker A., Landgraeber S., Haversath M., Li X., Zilkens C., Krauspe R., Jäger M. Long-term Clinical Results after Iloprost Treatment for Bone Marrow Edema and Avascular Necrosis. Orthop. Rev. (Pavia), 2016, vol. 8, no. 1, pp. 6150. DOI: 10.4081/or.2016.6150.

62. Meizer R., Radda C., Stolz G., Kotsaris S., Petje G., Krasny C., Wlk M., Mayerhöfer M., Landsiedl F., Aigner N. MRI-controlled analysis of 104 patients with painful bone marrow edema in different joint localizations treated with the prostacyclin analogue iloprost. Wien Klin. Wochenschr., 2005, vol. 117, no. 7-8, pp. 278-286. DOI: 10.1007/s00508-005-0326-y.

63. Jäger M., Zilkens C., Bittersohl B., Matheney T., Kozina G., Blondin D., Krauspe R. Efficiency of iloprost treatment for osseous malperfusion. Int. Orthop., 2011, vol. 35, no. 5, pp. 761-765. DOI: 10.1007/s00264-010-0998-4.

64. Glueck C.J., Freiberg R.A., Sieve L., Wang P. Enoxaparin prevents progression of stages I and II osteonecrosis of the hip. Clin. Orthop. Relat. Res., 2005, no. 435, pp. 164-170. DOI: 10.1097/01.blo.0000157539.67567.03.

65. Beckmann R., Shaheen H., Kweider N., Ghassemi A., Fragoulis A., Hermanns-Sachweh B., Pufe T., Kadyrov M., Drescher W. Enoxaparin Prevents Steroid-Related Avascular Necrosis of the Femoral Head. Scientific World Journal, 2014, vol. 2014, pp. 347813. DOI: 10/1155/2014/347813.

66. Peck K.A., Calvo R.Y., Schechter M.S., Sise C.B., Kahl J.E., Shackford M.C., Shackford S.R., Sise M.J., Blaskiewicz D.J. The impact of preinjury anticoagulants and prescription antiplatelet agents on outcomes in older patients with traumatic brain injury. J. Trauma Acute Care Surg., 2014, vol. 76, no. 2, pp. 431-436. DOI: 10.1097/TA.0000000000000107.

67. Saito T., Takeuchi R., Mitsuhashi S., Uesugi M., Yoshida T., Koshino T. Use of joint fluid analysis for determining cartilage damage in osteonecrosis of the knee. Arthritis Rheum., 2002, vol. 46, no. 7, pp. 1813-1819. DOI: 10.1002/art.10367.

68. Fransen M., Agaliotis M., Nairn L., Votrubec M., Bridgett L., Su S., Jan S., March L., Edmonds J., Norton R., Woodward M., Day R.; LEGS study collaborative group. Glucosamine and chondroitin for knee osteoarthritis: a double-blind randomised placebo-controlled clinical trial evaluating single and combination regimens. Ann. Rheum. Dis., 2015, vol. 74, no. 5, pp. 851-858. DOI: 10.1136/annrheumdis-2013-203954.

69. Burmakova G.M., Savchenko A.M. Vnutrisustavnaia ozonoterapiia v kompleksnom lechenii koksartroza [Intraarticular ozone therapy in complex treatment of coxarthrosis]. Meditsinskii Sovet, 2011, vol. 7-8, pp. 35-38. (in Russian)

70. Iliakis E., Bonetti M., Iliakis A. Osteonecrosis of the femoral head: Could oxygen-ozone therapy became a treatment option? Journal of Ozone Therapy, 2015, vol. 1, no. 1. DOI: 10.7203/jo3t.1.1.2015.12163.

71. Siemsen C.H. Ozon-Anwendung bei akuten und chronischen Gelenkerkrankungen [Use of ozone in acute and chronic joint diseases]. Beck E.G., Viebahn-Hänsler R., eds. Ozon-Handbuch. Grundlagen. Prävention. Therapie [Ozone Handbook. Basics. Prevention. Therapy]. Landsberg/Lech: Ecomed, 1995, V-9.2 1 - V-9.2 14. (in German)

72. Torgashin A.N., Rodionova S.S., Torgashina A.V. Ozonoterapiia – nedootsenennye vozmozhnosti v lechenii zabolevanii krupnykh sustavov [Ozone therapy – underestimated possibilities in the treatment of large joint diseases]. Sovremennaia Revmatologiia, 2019, vol. 13, no. 3, pp. 126–129. (in Russian)

73. Invernizzi M., Stagno D., Carda S., Grana E., Picelli A., Smania N., Cisari C., Baricich A. Safety of intra-articular oxygen-ozone therapy compared to intra-articular sodium hyaluronate in knee osteoarthritis: A randomized single blind pilot study. Int. J. Phys. Med. Rehabil., 2017, vol. 5, pp. 385. DOI: 10.4172/2329-9096.1000385.

74. Giombini A., Menotti F., Di Cesare A., Giovannangeli F., Rizzo M., Moffa S., Martinelli F. Comparison between intrarticular injection of hyaluronic acid, oxygen ozone, and the combination of both in the treatment of knee osteoarthrosis. J. Biol. Regul. Homeost. Agents, 2016, vol. 30, no. 2, pp. 621-625.

75. Issa K., Naziri Q., Kapadia B.H., Lamm B.M., Jones L.C., Mont M.A. Clinical characteristics of early-stage osteonecrosis of the ankle and treatment outcomes. J. Bone Joint Surg. Am., 2014, vol. 96, no. 9, pp. e73. DOI: 10.2106/JBJS.M.00888.

76. Nunley J.A., Hamid K.S. Vascularized Pedicle Bone-Grafting from the Cuboid for Talar Osteonecrosis: Results of a Novel Salvage Procedure. J. Bone Joint Surg. Am., 2017, vol. 99, no. 10, pp. 848-854. DOI: 10.2106/JBJS.16.00841.

77. Lawton C.D., Butler B.A., Dekker R.G. 2nd, Prescott A., Kadakia A.R. Total ankle arthroplasty versus ankle arthrodesis – a comparison of outcomes over the last decade. Orthop. Surg. Res., 2017, vol. 12, no. 1, pp. 76. DOI: 10.1186/s13018-017-0576-1.

78. Braito M., Dammerer D., Kaufmann G., Fischler S., Carollo J., Reinthaler A., Huber D., Biedermann R. Are our expectations bigger than the results we achieve? A comparative study analysing potential advantages of ankle arthroplasty over arthrodesis. Int. Orthop., 2014, vol. 38, no. 8, pp. 1647- 1653. DOI: 10.1007/s00264-014-2428-5.

79. Taniguchi A., Takakura Y., Tanaka Y., Kurokawa H., Tomiwa K., Matsuda T., Kumai T., Sugimoto K. An Alumina Ceramic Total Talar Prosthesis for Osteonecrosis of the Talus. J. Bone Joint Surg. Am., 2015, vol. 97, no. 16, pp. 1348-1353. DOI: 10.2106/JBJS.N.01272.

80. Yasui Y., Hannon C.P., Seow D., Kennedy J.G. Ankle arthrodesis: A systematic approach and review of the literature. World J. Orthop., 2016, vol. 7, no. 11, pp. 700-708. DOI: 10.5312/wjo.v7.i11.700.

81. Dhillon M.S., Rana B., Panda I., Patel S., Kumar P. Management Options in Avascular Necrosis of Talus. Indian J. Orthop., 2018, vol. 52, no. 3, pp. 284-296. DOI: 10.4103/ortho.IJOrtho_608_17.