Objective To search organizational solutions for improving quality of care for patients with chronic osteomyelitis (COM) based on many years’ experience of osteology infection clinic of the FBGI Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”. Material and methods 10 124 patients who received treatment for COM at the osteology infection clinic between 2011 and 2018 were enrolled in the study and causes of the condition identified. A staged organizational and functional model of specialized medical care was offered to launch osteology infection clinic with structural units, facilitate processing of the hospital database information and develop clinically based system for assessing quality of care. Results Review of the findings suggests that both medical and socioeconomic implications are involved in the treatment of COM and support needs to be considered for the patients. Conclusion Organizational and technological aspects are essential for management of patients with COM.

Introduction The article deals with a topic of how disorders of bone tissue metabolism affect the treatment outcomes after fractures of long bones complicated by chronic osteomyelitis. Purpose To study the feasibility of therapy aimed at correcting metabolic disorders in the bone tissue in patients with long bone fractures complicated by chronic osteomyelitis. Materials and methods Assessment of bone metabolic disorders in fractures of long bones complicated by chronic osteomyelitis, and of the effectiveness of treatment involving a combined therapy including surgical, antibacterial and anti-inflammatory treatment, and also a drug correction of the metabolic disorders detected. A retrospective study was conducted with stratified randomization of comparison groups. Results Changes in bone remodeling that are specific to this group of patients with increased resorption intensity were identified. In addition, high frequency of secondary hyperparathyroidism and metabolic disorders of the D hormone was observed in the patients with this pathology. The effectiveness of a combination of drugs for the correction of bone tissue metabolism disorders (calcium supplements, osseinhydroxyapatite complex, active metabolite of vitamin D and bisphosphonate) was evaluated by comparing the terms of consolidation. Conclusion Evidence was obtained of a significant reduction in the duration of treatment in the external fixation device by using the combined therapy aimed at correcting bone tissue metabolism.

Introduction The rate of complications after arthrodesis of the infected knee joint is 84 %, while the incidence of ankylosis failure varies from 17% to 80% thereby. At the same time, purulent process recurs in 50% of cases, and, moreover, 73% of patients report permanent pain after arthrodesis. Purpose of the study To evaluate long-term results of arthrodesis of the knee joint in patients with periprosthetic infection. Materials and methods Treatment results in 63 patients with periprosthetic infection of the knee joint who underwent arthrodesis using the Ilizarov apparatus in the period from 2005 to 2015 were assessed. The mean follow-up period was 8 ± 2.72 years (range, 3 to 13 years). There were 21 males (33%) and 42 females (6 %). Mean age of patients was 59.05 ± 9.64 years (range, 29 to 80 years). Results Re-infection occurred in 17 (27 %) out of 63 patients with arthrodesis procedures of the knee joint with the use of the Ilizarov apparatus. It was established that the results of arthrodesis of the knee depend on the bone defect size. Conclusions Arthrodesis of the knee joint with the use of the Ilizarov apparatus in patients with periprosthetic infection enables to eradicate infection in 73% of cases. Consolidation of fragments of the knee joint from the first attempt of arthrodesis was observed in 73% of patients.

Purpose Clinical substantiation of the effectiveness of the differentiated use of surgical techniques and technical means of fixation in the treatment of patients with periprosthetic infection that consider the local status of bone tissue and para- articular tissues. Materials and methods The work is based on the experience of surgical treatment of 97 patients with periprosthetic infection of the knee joint in the period from 2004 to 2016. Depending on the degree of bone damage after removal of implants, the patients were divided into three groups. The first one (n = 32; 33%) had type F1 and T1 bone defects according to AORI classification (Anderson Orthopedic Research Institute, USA); the second one had type F2A and T2A (n = 16; 16.5%), F2B and T2B (n = 26; 26.8%); the third one had F3 and T3 (n = 23; 23.7%). In the first group, only debridement was used. The second group patients underwent a two-stage revision with the installation of a spacer. The third group had arthroplasty in combination with osteosynthesis with the Ilizarov apparatus. Results Positive outcomes in patients of the first group were achieved in 100 % of cases, in patients of the second group in 82.5%, and in the third one in 92.2%. Complications happened in 30.9% of cases. Conclusion A differentiated approach with a multifactorial analysis of the infection causes, taking into account the risk factors, associated diseases that aggravate the infectious process, of the state of the implant and para-articular tissues, as well as the type of pathogen, its virulence and sensitivity to antibiotics is an effective rehabilitation option for managing patients with deep infection developed around the implant.

Background One-stage revision arthroplasty has currently a limited use in treatment of a periprosthetic infection despite obvious economic benefits in comparison with two-stage revisions. This operation involves the removal of all implant components, radical surgical debridement, joint irrigation, installation of a new implant, and a long course of antibiotic therapy. Purpose To evaluate the effectiveness of one-stage revision arthroplasty in the treatment of patients with periprosthetic infection of the hip joint. Material and methods Results of treatment of 14 patients with periprosthetic hip infection who underwent the procedure of a single-stage revision arthroplasty in the period from 2009 to 2018 were analyzed. The average follow-up was 2.7 years (range, 1 to 10 years). Results Twelve (86 %) out of 14 patients with periprosthetic infection of the hip joint completed one-stage treatment successfully. Two (14 %) patients developed recurrent infection and had a two-stage revision arthroplasty using an antibacterial spacer. In accordance with the Harris Hip Score scale, the functional state of the limbs at a one-years follow-up after treatment averaged 77.7 points (range, 36 to 95). Conclusions One-stage revision is quite a laborious medical procedure, for which sufficient experience of orthopedic surgeons and a specialized hospital service. This method of treatment provided suppression of infection in 86 % of our cases. Negative factors in using one-stage revision were polymicrobial infection and implant dislocation in the early postoperative period.

Introduction Management of infection associated with surgical implants comprise local application of antimicrobial agents. The purpose of the in vivo experimental study was identification of an optimal antimicrobial polymeric composition with hemostatic effect for local wound application and assessment of its influence on clinical and morphological changes in implant-associated infection caused by staphylococcus in rabbit femur. Materials and methods A composition exhibiting minimal bleeding time was identified in the first experiment using six experimental samples with different concentration of tranexamic acid (TXA) and polyvinylpyrrolidone (PVP) implanted in the soft tissue wound of the rat liver (n = 18). Peri-implant infection caused by staphylococcus was simulated in the rabbit femur in the second experiment. Infected wire was implanted in the intramedullary canal of control animals (n = 9). The wire was steeped in gentamicin-containing sample selected in the first experiment before it was used for experimental animals (n = 9). Histologic assessment of the wire placement site was performed at 14, 21 and 28 days. Results Minimal bleeding time was recorded with the sample containing 25 mg of TXA in 1 mL of 10 % PVP aqueous solution. 8 mg/mL of gentamicin was added to the sample tested. Both groups showed histological signs of inflammation at 14 days of implantation being more evident in controls with fibrinopurulent inflammation and microabscesses. Inflammatory infiltration was more expressed in controls at 21 days and was characterized by a great number of plethoric vessels. A capsule with leucocytes and fibrin clots was observed in the intramedullary canal. Experimental animals exhibited fading signs of inflammation with delicate fibrous tissue and moderate mononuclear infiltration formed. Signs of bone regeneration were detected in both groups at 28 days apart from persistent inflammation being secondary to decompactization. However, bone trabeculae were noted to recover in controls with evident inflammation featuring extensive erythrocyte clusters, necrotic bone fragments, granulated tissue and evident leucocyte infiltration. Conclusion The experimental study allowed identifying PVP and TXA based composition as most effective for hemostasis estimating dynamics in perifocal reactions with the use of gentamicin-containing sample to prevent osteomyelitis in implantation of experimental animals. The findings showed prospectiveness of further research of the polymeric composition with antimicrobial and hemostatic effects.

Introduction Biochemical parameters of synovial fluid constituents were reviewed in patients prior to total knee replacement (TKR). The diagnostic value of certain biochemical tests was identified as prognostic factors in the development of infection. Purpose Comparative biochemical analysis was performed for pathogenic microflora free synovial fluid of patients grouped according to characteristics of infectious complications prior to TKR. Material and methods Synovial fluid samples with isolated strains of Staphylососcus aureus, Klеbsiella sp. and aerobic gram-positive bacilli were excluded from the study. Total protein and its fractions, electrolytes, lipid peroxidation and catalase levels were measured in the synovial fluid. Electrolytes, lipid peroxidation and catalase were determined in the synovial fluid with exclusion of samples with identified aerobic gram-positive bacilli in bacterial culture. Results Preoperative assessment of synovial fluid showed changes in cholesterol concentration and systemic electrolyte index in TKR patients later grouped into periprosthetic infection and non-infection cases. No changes were seen in protein panel. Levels of total protein and albumin were elevated in both groups. Conclusion Our findings suggest that biochemical parameters of synovial fluid can serve as a prognostic tool for infection following TKR.

Background Infected nonunion of the distal femur is a very difficult entity to treat; it grossly affects daily living and adds economic burden to the society.There is no consensus on which surgical technique of its management leads to the best outcome. Materials and methods We reviewed 10 patients with infected nonunion of the distal femur and bone loss who were treated by radical surgical debridement and application of the Ilizarov external fixator from January 2010 to December 2015. Results The mean follow-up after removal of the frame was 18.6 months (range, 14 to 30 months). No patient was lost to follow-up. The mean external fixator time was 313.9 days (range, 275 to 362 days) which correlated with the final lengthening achieved. According to Paley’s grading system, eight patients had excellent clinical and radiological results and five excellent and good functional results. Bony union, ability to bear weight fully, and resolution of the infection were achieved in all the patients. Conclusion Distal femoral nonunion is a complicated orthopedic entity as it may be associated with nonunion, infection, bone loss, shortening, soft tissue scar, contracture, restriction of movement, disuse osteopenia. Ilizarov external fixation is a definitive treatment modality in these cases as it gives stability, allows early weight-bearing, compression/distraction at fracture site, helps to arrest infection and achieve union while corticotomy helps to regain length.

Introduction Osteomyelitic cavity is one of manifestations of chronic osteomyelitis (cOM) that requires continuous application of both non-operative and surgical interventions. The condition is often recurrent. The study of bone quality, techniques for identifying boundaries of pathological process should contribute to the development of advanced methods of treatment to avoid recurrence. Material and methods Radiomorphological assessment of the femur and tibia was performed for 48 patients with cOM characterized by osteomyelitic cavities using polypositional radiology and multislice computed tomography (MSCT) and quantification of bone density produced at the cavity and throughout the bone. Results Review of MSCT findings showed involvement through the cortical bone thickness of osteomyelitic cavity, structural changes in the entire bone with sinuses, sequestrae and alterations in the soft tissues (n = 40). Cortical bone was entirely involved in the cavity, with sinus observed and half-length of the bone featured with normal structure and low density in five patients. COM was diagnosed with present fixation metal constructs (n = 2) and recurrence noted after cavity repair with osteoinductive material (n = 1). Conclusion The findings showed that osteomyelitic cavity in patients with cOM resulted in extensive disorders of bone structure and density, evident changes in cortical bone, multiple layers, defects, considerable density fluctuations in intramedullary canal, in particular.

Introduction The increase in the number of primary hip joint arthroplasties leads to a steady increase in revision interventions. The category of complex arthroplasty also includes patients with extensive acetabular injuries due to high-energy trauma. Amplification of clinical cases requires an individual approach when planning the configuration of the acetabular component. In recent years, clinics have been actively introducing into practice the technology of 3D-modeling of hip replacement components. The purpose of the study was to assess the short and medium-term results of hip joint arthroplasty in posttraumatic coxarthrosis with significant bone defects, using individual acetabular components, with the presentation of clinical cases. Material was five arthroplasty cases operated using customized implants produced with a 3D printer. All five patients were males of working age who suffered high-energy injuries. Three of them had previous operations on the hip joint (from 1 to 5 operations). Anamnesis, characteristics of patients, bone defects types by Paprosky, follow-ups after surgery, X-ray data, the dynamics of the quality of life on the Harris scale were studied. Personalized acetabular components produced on a 3D printer were successfully implanted in four patients; in one case, the installation failed due to excessive lateralization of the rotation center and technical difficulties in adjusting the implant head. The follow-up period of three patients was 16.7 ± 3.7 months; two had operations three and 4 months ago respectfully. Results Dynamic assessment on the Harris scale in all patients showed an increase from 26 ± 5.2 to 77 ± 6.6 points. X-ray monitoring revealed a stable position of the implant components with satisfactory bone integration. Conclusion The study showed good short-and mediumterm results of the use of customized acetabulum components manufactured using a 3D printer in patients with significant bone defects of the acetabulum on the background of post-traumatic coxarthrosis.

Introduction Patellofemoral arthritis (PFA) began to be studied relatively recently. At present, there are no common approaches to the terminology, etiology and pathogenesis, as well as to the tactics of treating this disease. However, orthopediс researchers started to closely investigate the PFA, since its incidence is high in various populations (up to 36 and possibly higher). The main groups of patients are young and middle-aged people. The pathology is an obligatory predictor for development of classical knee osteoarthritis. Particular attention should be paid to the development of an approach to choosing a method of treating the disease. Material and methods A prospective cohort study was conducted, the type of study design was one group study of 88 subjects (48 women and 40 men aged 18–45 years, mean age: 31.5 ± 4 years). The method of surgical treatment was chosen with the help of a computer program developed by the authors, taking into account a number of indicators: 1) relevant clinical manifestations and data of quality of life questionnaires; 2) findings of radiation diagnostic methods and MRI. Postoperative follow-up was 3–6–12 months. Results The integral evaluation of the results obtained was analyzed using clinical cases. Discussion We developed a program for assessing the condition of the knee joint for abnormalities in the patellofemoral articulation. It demonstrated good evaluation results, which were instrumentally confirmed by such precise diagnostic methods as MRI / CT and arthroscopy. The program contains integral information of important criteria, specific for normal biomechanics of the patellofemoral joint: quadriceps angle (Q-angle), patellar type, trochlear dysplasia, Insall-Salvatti index and TT-TG distance. In addition, it uses modern scale system assessment, containing not only subjective, but also objective parameters for evaluating the function of the knee joint.

Introduction Despite significant steps in prevention and treatment of infectious complications after surgical treatment on the spine, many issues remain unsolved. There is a sufficient number of scientific reports on the treatment of postoperative infection, however, only a few studies present multivariate analysis of risk factors of developing deep infection after surgical intervention. In the domestic literature, such reports are rare. According to most sources, the rate of infection after spinal interventions ranges from 0.7 to 11.9 %. Material and methods We conducted a retrospective multivariate analysis of the data collected to determine the risk factors of deep surgical infection after spinal surgery at various levels and volumes. To fully determine the risk factors, not only surgical factors were evaluated, but also individual characteristics of patients contributing to the increase in infection rates. The purpose of this study was to compare patients who developed local deep infection after spine surgery, with a randomly selected group of patients who did not develop this complication, to identify modifiable risk factors. Results In the period from 2005 to 2016, we identified 79 cases of postoperative deep infection. The overall morbidity rate after 5564 operations (in 5328 patients) was 1.48 %. The most common causative agent of the infectious process was S. epidermidis MRSE. All patients underwent at least one revision intervention, with additional antibiotic therapy course. To reduce the number of infectious complications in patients at risk, preventive measures were carried out, including changes in the volume and type of surgery, prolonged administration of antibacterial drugs, etc. Of the surgical risk factors, the greatest differences between the groups were noted in the types of surgical interventions, implementation of spondylodesis, and previously performed operations on the spine. Also, the risk of purulent-septic complications increased in high BMI, diabetes and urinary tract infection. Conclusion The conducted multivariate analysis reliably confirms the significance of the risk factors identified.

Objective To assess antimicrobial characteristics of original bone xenomaterial implants with vancomycin impregnated with different technologies. Material and methods Bone xenomatrix was modified with two technologies of vancomycin adsorbed on the surface of the material and vancomycin adsorbed in the volume of the material through intermediate carrier. Antibiotic was impregnated using supercritical fluid extraction with carbon dioxide. Antibiotic release from modified xenomaterial was evaluated and antimicrobial activity against S. aureus assessed in vitro. Results Elution of vancomycin over 24 hours from the material produced with absorption technology was 98 % of baseline content in the matrix. Residual content of antibiotic was 1.75 % on average. The use of intermediate carrier (L/D polylactide isomer) allows for obtaining material with gradual prolong vancomycin release. Major release (68.16 % from baseline content) of vancomycin occurred smoothly over the first 14 days. Bone block eluted 22 % of the residual antibiotic load by 30 days of incubation. The products impregnated with antibiotic using two different technologies exhibited evident antimicrobial activity against S. aureus. Conclusion Technologies developed to impregnate vancomycin in xenogenic bone matrix are practical to obtain new modified bone grafting material with evident antimicrobial activity.

The authors of the study analyzed the works on traumatology and orthopedics published by the employees of the Ilizarov Center in the period between 2008 and 2018 and their citations in scientific journals that are part of the Scopus bibliographic database. The total number of publications, the number of cited articles and the number of citations for each article in Scopus were assessed. Ranking and categories of journals that published and cited these articles, the dependence of rating indicators of publishing and citing journals, the dependence of the number of citations on the origin of journals (foreign or Russian) and on the affiliation of the authors who cited the Center’s articles were analyzed.

Objective To explore decision support systems (DSS) used in spine-pelvic surgery, analyze its functional possibilities and approaches that allow the surgeon to make a correct decision. Material and methods Functional possibilities with modern DSSs used in surgery of spine-pelvic complex were reviewed with unified criteria using websites of DSS manufacturers and publications in scientific journals. Results MediCAD, TraumaCAD, Surgimap, Sectra AB and OrthoView are most common DSSs used for spine and hip surgery planning. The above systems can be applied in orthopedic surgery of several independent anatomical regions (e.g., spine, pelvis, femur, tibia, foot). But none of the systems can be applied to spine-pelvic complex. DSS facilitates only geometrical planning with geometric measurements, simulation of physiologically normal location of anatomical elements as well as selection and semi-automatic implant positioning. Conclusion Both geometrical planning and biomechanical simulation are required to achieve positive long-term follow-up of surgical treatment. Biomechanical simulation allows assessment of an extent and pattern of injury caused by malalignment of spine-pelvic complex and surgical intervention planning with the help of reconstruction options offered. The use of DSS should involve geometric planning, biomechanical simulation of the expected surgical outcome and prediction of a long-term follow-up. Introduction of DSS into clinical practice will facilitate the quality of medical care and rehabilitation with concurrent optimization of the national expenditure on health care.

Introduction High-energy tibial fractures are challenging injuries to treat. Objective We report a case of a tibial gunshot fracture treated at several stages. Material and methods The fracture was first stabilized with external fixation device. The second stage aimed at the arrest of infection consisted of excision of necrotic tissues, placement of antibacterial spacer and repair of compromised soft tissues. Reconstructive surgery was produced at the third stage of treatment to address bone defect and provide consolidation. Results and discussion The Masquelet induced membrane technique, compression osteosynthesis with the Ilizarov frame and non-free autograft using fibular fragment facilitated recovery of supporting tibia functions within a relatively short period of time. Conclusion The combination of stimulating effects from different surgical techniques is useful to ensure a good outcome in a severe clinical case scenario.