RU2446764C2 - Method of endoprosthtics of large joints - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics, and can be applied in endoprosthetics of large joints by means of press-fit endoprosthesis fixation. Before performing fixation KOLLOST gel preparation is applied on implantation surface of endoprosthesis.

EFFECT: application of claimed invention makes it possible to increase reliability of biologic fixation of endoprosthesis in bone bed by creation of conditions for local stimulation of osteogenesis due to properties of preparation which ensure filling all present on implantation surface roughness and interosseous spaces in area of contact bone-metal, additionally contributes to preservation and strengthening of bone bed structure.

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Description

The invention relates to medicine, namely to traumatology and orthopedics.

Known methods for arthroplasty of large joints, in which they carry out tight mechanical fixation (press-fit) of the arthroplasty due to the difference in the size of the arthroplasty and the prepared bone bed. As a rule, the size of the endoprosthesis should be 1-2 mm larger than the bone bed, this ensures primary stable fixation. An additional - biological - fixation of the endoprosthesis occurs due to the ingrowth of bone tissue into the surface of the endoprosthesis (Guidance on hip joint replacement / edited by Tikhilov PM, Shapovalov V.M. - St. Petersburg: RRIIITO named after PPVredena, 2008. - P. 42- 43, 47-48, 60-61, 89). Biological fixation implies an anatomical and functional relationship between the living bone and the surface of the endoprosthesis, is one of the factors ensuring the stability of the endoprosthesis and proceeds similarly to the processes of primary fusion of the fracture - the inflammation phase, the repair phase, the remodeling phase (Holodaev M.Yu. Biological fixation of the endoprosthesis with total arthroplasty of the hip joint: dis. ... candidate of medical sciences. - 2006. - S.14-16). In order to improve the conditions of biological fixation, the outer surface of the endoprosthesis during its industrial production is roughened and / or porous (special coatings in the form of tiny balls, wire; plasma spraying of titanium). The rate of bone tissue germination into the surface coating of the endoprosthesis depends on the qualitative and quantitative state of the bone tissue adjacent to the endoprosthesis, the patient's individual characteristics (age, gender), diseases, and bad habits. The insufficient reliability of biological fixation with a predominance of resorption processes and a deficit of bone mass in the area of contact between the bone and the surface of the endoprosthesis leads to the development of aseptic loosening of the components of the endoprostheses. According to the literature, the frequency of this complication in the first 5-6 years after surgery is from 8 to 16.1% (Klyushnichenko I.V. Implant-independent risk factors for the development of aseptic instability of hip joint endoprostheses: dis. ... Ph.D. in medical science. - 2008 .-- S. 6, 13, 106-125).

A known method of hip joint arthroplasty by press-fit fixation is that prior to press-fit fixation, a layer of hydroxyapatite (Rothman RH, Hozack WI at al. Hydroxyapatite-coated femoral stems. A matched- pair analysis of coated and uncoated implants // J. Bone Joint Surg. - 1996 / vol. 78-A. - No. 3. - March. - pp. 319-324). Hydroxyapatite is non-toxic, has the ability to quickly and completely osseointegrate due to its chemical composition, which is almost identical to bone tissue - the content of calcium phosphate is more than 98%.

However, the disadvantages of this method include the fact that the coating of hydroxyapatite undergoes resorption over time, which impairs the stability of the endoprosthesis. In the distant period, a coating of hydroxyapatite often splits and separates from the titanium base, creating conditions for aseptic loosening of the endoprosthesis. (Kholodaev M.Yu. Biological fixation of the endoprosthesis in case of total arthroplasty of the hip joint: dis. ... Ph.D. medical sciences. - 2006. - P.22.) This method is adopted by us as a prototype.

The objective of the invention is to increase the efficiency of arthroplasty of large joints due to the prevention of aseptic loosening of the components of endoprostheses.

The technical result consists in increasing the reliability of the biological fixation of the endoprosthesis in the bone bed.

This is achieved due to the fact that before the implementation of stable fixation of the endoprosthesis in the press-fit bone bed, the KOLLOST gel is applied to its implantation surface.

Unlike hydroxyappatite KOLLOST gel is a sterile collagen material with a fully preserved native structure. Its main advantage is that it retains the three-helix structure of the fiber, and it is a matrix for targeted tissue regeneration and activation of the synthesis of its own collagen. Gradually, slowly dissolving in the bone bed, it is replaced by the patient’s own connective tissue, increasing the thickness of the osteoid layer. Substitution takes place in a strictly directional manner, therefore, random growth of granulation tissue around the component of the endoprosthesis, which weakens its fixation, is excluded. Due to its consistency - the gel - the KOLLOST preparation fills with itself all the irregularities and interosseous spaces existing on the surface of the endoprosthesis in the bone-metal contact area (Instructions for use of the collagen absorbable material KOLLOST gel. CJSC Bio Farmaholding).

The method is as follows: after standard access to a large joint is performed according to the template, the joint end is resected at a predetermined level, the joint is revised, soft tissue formations are removed, and the bone bed of the joint surface of the bone is successively formed with a set of cutters and rasps to install the components of the endoprosthesis. Before the final installation of the components of the endoprosthesis, a layer of COLLOST gel is applied to the implantation surface of the endoprosthesis. The wound is repeatedly washed with antiseptic solutions. A tubular drainage is placed under the neck of the endoprosthesis. The wound is sutured in layers tightly. Apply an aseptic dressing.

Clinical example.

Patient T., 59 years old, and / b. No. 1420., 11.02.2010 was admitted to the XI orthopedic department of the City Clinical Hospital No. 59 with complaints of pain in the right hip joint. Pain has been troubling since 2004, which has gradually progressed.

Movements in the right hip joint are painful: flexion - 90 °, extension - 175 °, abduction - 0 °, adduction - 10 °, rotation outwards - 5 °, inwards - 0 °. The relative shortening of the right lower limb is about 1 cm. During an X-ray examination of the hip joints dated February 15, 2010, total aseptic necrosis of the head of the right thigh was diagnosed. The mushroom-shaped femoral head is fragmented, enlarged, the femoral neck is osteoporotic, enlarged and shortened. The trochanteric region of the femur with the phenomena of pronounced osteoporosis, thinning of the cortical walls at the subtrochanteric level. The joint gap is unevenly narrowed. The acetabulum is increased in vertical size with protrusive thinning of the bottom. Above the articular contour of the roof is common osteoporosis.

Diagnosis: Posthormonal aseptic necrosis of the head of the right femur IV stage. Osteoporosis.

After the clinical and radiation methods of examining the patient, the operation was performed on February 27, 2010: total endoprosthesis replacement of the right hip joint, with an endoprosthesis of the Biomet company with a metal - metal friction pair.

Technique of operation: front access to the joint. After arthrotomy of the hip joint, a resection of the articular end of the thigh at the level of the base of the neck was performed according to the template. The resected femoral head is sharply deformed, the integumentary layer is detached from the avascular fragmented subchondral bone. The acetabulum is large, excessively deep, devoid of cartilage. Patches of sclerosis alternate with cysts of various sizes. The round ligament does not bleed.

The phased formation of the implant bed for the cup and leg of the Biomet endoprosthesis was performed. In order to prevent loosening of the components of the endoprosthesis before their implantation, a layer of COLLOST gel is applied alternately on the implantation surface of the cup and leg. After that, the components of the endoprosthesis were firmly fixed by press-fit. After the head is repositioned, the endoprosthesis is stable in all extreme positions. Drainage to the neck of the endoprosthesis. Layer wound closure. Stitches to the skin. Rubber graduates. Aseptic dressing. X-ray control from 03/01/2010

The patient is activated on the 3rd day after surgery. Walking on crutches is allowed with a full load on the operated leg. The postoperative wound healed by primary intention. Sutures were removed on day 14. Discharged for outpatient treatment with recommendations for monitoring an orthopedist at the place of residence. On an active call came to control.

Claims (1)

The method of endoprosthetics of large joints by means of fixation of a press-fit endoprosthesis, characterized in that before the implementation of the fixation of a press-fit endoprosthesis, a COLLOST gel is applied to its implantation surface.