Premature hip replacement in osteoarthritis

Authors:

Tkachenko Aleksandr Nikolaevich, Grand PhD in Medical Science, professor of Department of traumatology, orthopedics and military field surgery, North-West State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Ave, Saint-Petersburg, 195067, Russian Federation; e-mail: altkachenko@mail.ru; https://orcid.org/0000-0003-4585-5160.

Deev Roman Vadimovich, PhD in Medical Science, Head of department of pathological anatomy, North-West State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Ave, Saint-Petersburg, 195067, Russian Federation; e-mail: roman.deev@szgmu.ru; https://orcid.org/0000-0001-8389-3841.

Starchik Dmitrii Anatolyevich, Grand PhD in Medical Science, Head of the department of human morphology, North-West State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Ave, Saint-Petersburg, 195067, Russian Federation; e-mail: dmitrii.starchik@szgmu.ru; https://orcid.org/0000-0001-9535-4503.

Khaidarov Valerii Mikhailovich, PhD in Medical Science, associate prof. of department of traumatology, orthopedics and military field surgery, North-West State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Ave, Saint-Petersburg, 195067, Russian Federation; e-mail valerii.khaidarov@szgmu.ru; https://orcid.org/0000-0002-0754-4348.

Mansurov Djalolidin Shamsidinovich, PhD in Medical Science, head of department of radiation diagnostics and therapy, Samarkand state medical university, 18 Amir Temura Street, Samarkand, 140100, Uzbekistan; e-mail: jalolmedic511@gmail.com; https://orcid.org/0000-0002-1799-641X.

Sementsov Konstantin Valeryevich, Grand PhD in Medical Science, associate prof. of department of general surgery, North-West State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Ave, Saint-Petersburg, 195067, Russian Federation; Head of the hospital for surgery “Hospital for War Veterans”, 21/2 Narodnaya Street, St. Petersburg, 193079, Russian Federation; e-mail: konstantinsementsov@gmail.com; https://orcid.org/0000-0003-1056-3168.

Polikarpov Andrei Vasilyevich, head of traumatology and orthopedics of department “Hospital for War Veterans”, 21/2 Narodnaya Street, St. Petersburg, 193079, Russian Federation; e-mail: dr.polikarpov@gmail.com; https://orcid.org/0000-0002-1145-5030.

Kakhkharov Azizbek Sirozhitdinovich, teacher of department of traumatology and orthopedics, Samarkand state medical university, 18 Amir Temura Street, Samarkand, 140100, Uzbekistan; e-mail: azizbek.kakhkhorov.90@mail.ru; https://orcid.org/0000-0003-3815-952X.

Presnyakov Evgenii Valerievich, resident doctor of department of pathological anatomy, North-West State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Ave, Saint-Petersburg, 195067, Russian Federation; e-mail: uvpres@gmail.com; https://orcid.org/0000-0003-1546-5129.

Savitski Viachaslav Dmitrievich, student, St. Petersburg State University, 7-9-11 Universitetskaya Embankment, St. Petersburg, 199034, Russian Federation; e-mail: slava_savitski@mail.ru; https://orcid.org/0000-0002-7367-7528.

Annotation:

Introduction. Both in Russia and around the world, there is an annual increase in the number of knee replacement surgeries (KR), the improvement of implant designs and the modernization of arthroplasty technologies, along with the accumulation of practical experience, have not led to a significant reduction in the frequency of complications, negative outcomes and unsatisfactory quality of life. In recent years, the number of publications devoted to the unjustified conduct of KR has been increasing. The article is devoted to the analysis of the possibilities of morphological studies in order to determine the validity of arthroplasty.

Materials and methods. In the clinic of traumatology and orthopedics of St. Petersburg State Medical University named after I.I. Mechnikov from 01.01.2022 to 15.12.2022, 187 KR in patients with osteoarthritis were performed. Materials from 30 patients aged 40 to 76 years (19 women, 11 men) were taken by random sampling for morphological examination. The production of histological preparations was carried out according to the standard procedure for bone tissue, the studied bone fragments were decalcified in an electrolyte decalcifying solution (Biovitrum, Russia). Histological wiring, filling, and microtomy with a slice thickness of 5 microns were carried out according to the standard procedure. The preparations were stained with review dyes (hematoxylin and eosin) and safranin O.
Histotopograms of 5 femoral heads plastinated with epoxy resin were studied at the mesoscopic level. Additionally,
5 pelvis with confirmed intravital diagnosis of osteoarthritis of the hip joint (3 men and 2 women), were sectioned frontally and horizontally and plastinated with epoxy resin to study macroscopic and mesoscopic features.

Results. Only 48 (25.7%) patients before the KR were at least once on a course of inpatient conservative or minimally invasive surgical treatment for OA of knee joint. Intraoperative and postoperative complications were noted in 18 (9.6%) patients. Among the 30 morphological studies conducted, 3 (10%) patients had stage I OA of knee joint verified; 8 (26.7%) cases were diagnosed with osteoarthritis of the II stage, and 19 (63.3%) — osteoarthritis of the III stage.

Discussion. Many authors rightly believe that the service life of the implant is not unlimited, and unsatisfactory results of KR are often noted due to wear of the endoprosthesis. Publications concerning premature or unjustified KR, as one of the reasons for the negative results of osteoarthritis treatment, are increasingly found in both domestic and foreign literature. The discussion about indications and contraindications to knee arthroplasty continues.

Summary. Among the patients who underwent KR, only one in four (48 people — 25.7%) was at least once on a course of inpatient conservative or minimally invasive surgical treatment for OA of knee joint. According to the morphological study, 11 (36.7%) clinical cases who underwent arthroplasty had stage I — II OA of knee joint verified. To form a strategy for the treatment of patients with OA of knee joint, it is necessary to develop an algorithm for interaction between specialists with the involvement of therapists, orthopedists, rheumatologists, rehabilitologists and specialists in restorative medicine of both outpatient and inpatient and sanatorium-resort units in the process.

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