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Relevance Diabetic neuroosteoarthropathy (DNOAP) complicated by chronic osteomyelitis (CO) is one of the most common complications (up to 7.5 %) in patients with diabetes mellitus. Treatment failure of such patients leads to amputation of the segment, and in some cases, to death. The use of the method of transosseous osteosynthesis is the only alternative method in the struggle for the limb salvage. Purpose Based on X-ray morphological criteria for assessing bone quality, to determine the optimal assembly of the external fixation device (EFF), which provides favorable conditions for restoring limb weight-bearing capacity in the treatment of patients with DNOAP complicated by infection. Materials and methods The analysis of radiographs and the clinical course of the reparative process in 49 patients (mean age 55.5 ± 9.4 years) with DNOAP complicated by chronic osteomyelitis was carried out. Two groups were distinguished based on the Ilizarov apparatus assembly: wire-based (WB) used in 25 patients; hybrid construct (HC) in 24 patients. The X-ray obtained in Jpeg format were analyzed using specialized Hi-scene software. The density of the bones of the foot was studied by MSCT. Results Comparison of the indicators of bone optical density in both study groups showed that there was an insignificant increase in the postoperative period Od of the calcaneus by 25 % after treatment in patients from the HC group, and in the WB group by 43 % in the distal tibia. At the same time, we noted a significant increase in the Od values of the tibia in the postoperative period in patients from the HC group and in the body of the calcaneus in patients from the WB group. MSCT showed that the density of the calcaneus before treatment in patients with DNOAP in the region of the calcaneal tubercle was 194.37 ± 49.05 HU, in the region of the body it was 205.47 ± 38.36 HU, in the region of the distal tibia 280.00 ± 40.30 HU. The analysis of the results of bone osteosynthesis of the affected segment showed that the rate of satisfactory outcomes after dismantling the device in patients from the HC group was significantly higher than in the WB group (56 %) and amounted to 75 %. Discussion As is known, pronounced osteoporosis of the bones of the lower leg and foot is often characteristic of patients with diabetes mellitus complicated by DNOAP and chronic osteomyelitis. A possible arsenal of treatment methods that allow solving the problems of stable arrest of the osteomyelitic process and restoring limb support in such patients is very limited. The optimal choice of the Ilizarov apparatus assembly type has an impact on the outcome of treatment of patients with this pathology. Conclusion Based on X-ray morphological criteria for assessing bone quality, our study showed a decrease in optical and densitometric bone density in patients with DNOAP complicated by chronic osteomyelitis compared to the norm. The use of wire-based assembly of the apparatus does not provide sufficient conditions for the solution of the set of the surgical tasks in this category of patients. The introduction of half-pins into the apparatus system provides the necessary fixation time with the possibility of functional load on the operated segment in patients in the postoperative period.

Background Conventional radiography, magnetic resonance imaging, nuclear medicine scintigraphy are the imaging techniques currently in use for the evaluation of diabetic neuroosteoarthropathy (DN) with computed tomography being not commonly employed even for cases complicated by chronic osteomyelitis. The objective was to explore MSCT-semiotics of anatomical and radiomorphological changes in foot bones in patients with DN complicated by chronic osteomyelitis (CO) to determine most common manifestations of CO in diabetic foot. Material and methods Single-centre retrospective study. A series of cases. Preoperative radiological findings, MSCT (multislice computed tomography) were examined in 14 patients with DN complicated by chronic osteomyelitis. Results The patients showed impaired structure of the cancellous bone of various severity depending on the nature and localization of foot bone destruction. Overall bone density was higher in cancellous bone of the distal tibia, talus, calcaneus with the local density ranging within significant limits and was maximum at some points of the subchondral tibia and talus and minimum in the intertrabecular areas of the calcaneus and the distal tibia. MSCT scans showed medial calcinosis of the arteries in 5 (35.7 %) from 14 patients. Conclusion MSCT as one of the most objective method for the qualitative and quantitative assessment of the bone is practical for identifying anatomical and topographic relationships of the foot bones and the ankle joint to facilitate reconstructions in three planes and VRT, which is important for assessing the foot in patients with DN complicated by chronic osteomyelitis. The technique allows measurement of the foot bone density in Hounsfield units determining the severity of osteoporosis, the extent of architectonics impairment to facilitate preoperative planning.

Introduction It is known that the density of the cortical plate of long bones in patients with chronic osteomyelitis changes throughout its extension. However, the nature of structural disorders in the cortical layer outside the inflammation zone has not been studied well. Purpose To study the structural features of the cortical plate of the femur and tibia outside the focus of inflammation to identify microcavities and microabscesses. Material and methods The study is retrospective conducted at one center. Evidence level IV. In 92 patients with chronic osteomyelitis of long bones of the lower extremities, using polypositional radiography and multislice computed tomography (MSCT), the features of radiological morphology of the femur and tibia were studied in order to reveal structural features of the cortical plate and identify microcavities. Results The cause of osteomyelitis in 5 cases was a consequence of hematogenous osteomyelitis, and in 87 cases it developed due to trauma or surgery. The most common location of chronic osteomyelitis was the distal femur and tibia. Anatomical changes in the femur and tibia in all patients had individual differences. Radiological morphological manifestations such as local and general osteoporosis, foci of osteosclerosis, architectonic disorders occurred in all patients. However, the severity of changes in the bone structure was extremely diverse, including the changes in bone density. Conclusion The data obtained indicate that radiological morphological changes in the cortical plate outside the zone of destruction are manifested by formation of microcavities and microabscesses in 15.6 % of patients, what plays an important role in possible recurrence of osteomyelitis.

Introduction The use of laboratory tests to monitor the treatment of patients with chronic osteomyelitis has a lot of clinical relevance. The purpose of the study was to identify laboratory tests for assessing metabolic processes in patients with purulent lesions of the foot bones for monitoring the dynamics of the recovery processes in the course of treatment. Methods The studies were carried out in 36 patients with chronic osteomyelitis of the calcaneus and adjacent bones of the foot of traumatic etiology. All patients were treated with the method of the Ilizarov transosseous osteosynthesis. Biochemical and coagulation parameters were studied. Results It was found that in patients with purulent lesions of the foot bones, the elevated levels of blood serum lactate were most frequently detected before surgery (52.8 %, 95 % CI: 36.6-68.6). The incidence of elevated CRP was 27.7 % (95 % CI: 14.6-43.3) on average, and one third of patients had elevated fibrinogen levels (33.3 %, 95-CI: 19.1-49, 3). During the treatment period, the incidence of elevated lactate levels in patients did not change but the incidence of elevated CRP levels increased significantly which was observed in 77.8 % of patients on the 3rd post-surgery day. By discharge from the hospital, elevated values of CRP and lactate occurred in 11.1 % of patients. It is assumed that the greatest diagnostic significance is the assessment of the level of lactate in the dynamics of the treatment in target patients. Discussion Based on the results of the studies, a laboratory sign was found that indicates the effectiveness of surgical treatment in patients with chronic osteomyelitis of the foot bones using the method of transosseous osteosynthesis. Such a sign is a decrease in the initially elevated concentration of lactate in the blood serum of patients in the postoperative period. The detected sign meets the requirements for its applicability in laboratory tests: 1) this sign is the most common in the target group of patients; 2) the dynamics of changes in the level of lactate correlates with the ongoing treatment; 3) this test is an indicator of a significant physiological process: oxidative metabolic processes in patients with the studied pathology.

Introduction It is known that the function and structure of the muscles of the thigh and lower leg are closely related to the function of the lower limb, which is impaired to one degree or another in all patients with chronic osteomyelitis. However, the nature of structural changes in the muscles, which, in turn, affect the condition of the bones, has not been well studied. Purpose of the work To study the features of changes in the muscles of the thigh and lower leg in patients with chronic osteomyelitis according to MSCT data. Material and methods The study is retrospective conducted at a single centre of Evidence level IV. Multislice computed tomography (MSCT) was used in 112 patients with chronic osteomyelitis of long bones of the lower extremities to study the radiological morphology of the muscles of the thigh and lower leg, including density, muscle belly area, and anatomical features. Twenty patients had chronic osteomyelitis in the area of transosseous elements (pins). The mean age of the patients was 48.5 ± 9.8 years. Males prevailed among the patients (87.5 %). The cause of osteomyelitis in 107 cases was trauma or surgery, five patients had consequences of hematogenous osteomyelitis. Results The results of the study showed that the muscles of the thigh and lower leg in patients with chronic osteomyelitis have pronounced dystrophic changes. In 89.4 % of patients, they were manifested by an increase in the density of the anterior tibial muscle, long extensor of the toes (84.7 %), peroneal muscles (78.5 %) and a decrease in the density of the head of the gastrocnemius muscle (91.3 %). In 10.6 % of the patients, there was a decrease in the density of the anterior tibial muscle, the long extensor of the fingers. In all patients with chronic osteomyelitis of the femur, the density of the muscles of the anterior and posterior groups was reduced, except for the musculus vastus intermedius of the thigh that was characterized by fibrotic changes with an increase in density. Conclusion The data obtained indicate that radiological morphological changes in muscles occur in all patients with chronic osteomyelitis of the femur and lower leg. The most pronounced alterations in the architectonics were in the anterior tibial and gastrocnemius muscles, and the intermediate broad muscle of the thigh.

Introduction Literature data and analysis of our own material indicate a change in the density of the long bone cortical plate in patients with chronic osteomyelitis along its extension; however, the nature and degree of structural disorders of the cortical layer beyond the inflammation zone is an unexplored area of radiomorphology. Objective To study the structural features of the cortical plate of the femur and tibia outside the inflammation nidus and the change in its structure in the form of trabecularization. Material and methods The study is retrospective single-center work of level of evidence IV. In 86 patients with chronic osteomyelitis of the long bones of the lower extremities, using polypositional radiography and multislice computed tomography (MSCT), the features of radiological morphology of the femur and tibia were studied in order to identify structural features and quantify the density of the cortical plate and its trabecularization. Results The cause of the inflammatory process in the bone in 83 cases was trauma or surgery, and consequences of hematogenous osteomyelitis in three cases. The most common location of chronic osteomyelitis was the distal femur (24) and tibia (25) bones. Due to long-term disease, nonunion or a bone defect developed in 11 patients. Analysis of MSCT data in 86 patients with chronic osteomyelitis showed that anatomical changes in the femur and tibia and the density characteristics of the cortical plate near the focus of destruction were manifested in 79.5 % of patients with a decrease in the thickness of the cortical plate (up to 2 mm) with complete trabecularization in separate areas with density from 290 to 360HU in 47.7 % of the examined. Conclusion Radiological morphological changes in the cortical plate of the femur and tibia in patients with chronic osteomyelitis near the focus of destruction were characterized by a decrease in the thickness and density of the cortical plate, accompanied by its complete or partial trabecularization with a density not exceeding 315.5 ± 38.6 Hounsfield units (HU) in 41 ( 47.7 %) of 86 patients.

Abstract. Introduction Periprosthetic infection in hip arthroplasty is a social and economic problem. Its main reason is multidrug resistance of microorganisms. Purpose To evaluate the effectiveness of the first stage in two-stage revision arthroplasty for the treatment of deep periprosthetic infection of the hip joint by improving the constructive and antibacterial features of spacers. Materials and methods The treatment results of 127 patients with late deep periprosthetic hip joint infection who underwent two-stage revision arthroplasty in the period from 2015 to 2019 were analyzed. In the first group, 42 patients were fitted with a two-component (total) spacer based on the developed antimicrobial composition of bone cement with gentamicin, antiseptics and polymer (patent RU 191236). In the second group, a two-component spacer (patent RU 174697) based on conventional bone cement with gentamicin was implanted in 43 patients; the third group of 42 patients had a preformed spacer. Results A bactericidal and antiadhesive, nontoxic composition based on bone cement with gentamicin with antiseptics poviargol, dioxidine and high molecular weight polyvinylpyrrolidone with a prolonged action for 348 days against gentamicin-resistant staphylococci has been developed. All patients underwent the first stage of hip arthroplasty with removal of the implant and installation of a spacer. Recurrence of periprosthetic infection was observed in 1 (2.3 %) patient of the first group, in 5 (11.6 %) in the second and in 6 (14.2 %) patients of the third group. Non-infectious complications such as spacer dislocation and instability were observed in 12 cases, one case (2.3 %) in the first, 2 (4.6 %) in the second and 9 (21.4 %) in the third group. The average time from the first stage of treatment to the second stage of re-implantation was 7.5 months (range, 4–13 months). Discussion According to the literature, the introduction of new antibiotics into the bone cement with gentamicin does not increase the antimicrobial action of the spacer, especially against antibiotic-resistant isolates, and the use of a preformed spacer contributes to an increase in the number of non-infectious complications. Antiseptics with different mechanisms of action are able to act on antibiotic-resistant bacteria, and the polymer can prolong this effect. Conclusions Creation of two-component spacers based on bone cement with gentamicin using antiseptics with different mechanisms of action and polymer promotes long-term bactericidal action of the spacer, which leads to effective sanation of the joint area, reducing non-infectious complications.

Abstract. Introduction Re-infection rates remain high after revision for periprosthtic joint infection (PJI). We conducted a complex diagnostic study of hip PJI and studied bone tissue involvement into the infectious process. Material and methods Twenty-nine patients treated for PJI were examined. Ten patients had acute, seven had late and 12 hematogenous infection (Tsukayama, 1996). Clinical, laboratory, microbiological, radiographic and histological methods were used for PJI detection. Results ESR exceeded the threshold in 16 and CRP in 23 cases. Pathogenic microorganisms were confirmed in 23 cases. Radiographic manifestations of periprosthetic bone destruction were seen in 14 patients with late and hematogenous infection. The histological study showed signs of osteomyelitis in 19 patients, including five cases with acute PJI. Histological study of periprosthetic and pseudosynovial membranes revealed PJI in 20 patients. The histological and microbiological tests together confirmed PJI in 27 cases (92 %). ROC analysis showed that the accuracy of CRP in the diagnosis of osteomyelitis exceeded that of ESR due to its higher sensitivity. Microbiological tests showed satisfactory sensitivity but low specificity. The radiographic study had an extremely low sensitivity and low specificity. Histology of membranes was quite sensitive and specific for the diagnosis of osteomyelitis but did not reach the level of bone histology. Conclusions Our complex diagnostic study has enabled to accurately characterize the septic process in revision arthroplasty. The histological findings show that osteomyelitis of different severity might develop in each PJI type. This fact may be a key factor for a surgeon in choosing a more reliable treatment option.

Introduction There is a lack of studies analyzing the molecular aspects of body functioning in purulent complications of bone tissue. The purpose of the review was to explore the serum vascular endothelial growth factor (VEGF) levels in patients with high-energy trauma complicated with infection. Material and methods The study included 36 individuals who sustained a high-energy injury. The participants were identified as no-infection patients (Group I) and those who developed infection during treatment (Group II). Enzyme immunoassay was employed to quantify VEGF with Thermofisher immunoassay analyzer (USA). The study was performed according to the methodology from the R & D Systems kit manual (Angiopoietin-1 and -2 (Ang-1, Ang-2)), platelet-derived growth factors (PDGF-AB, PDGF-BB), Invitrogen (epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), RayBiotech (macrophage stimulating protein (MSP), Biomerika Inc. (Calcitonin-calciotonin) USA) and Immunodiagnostic (bone sialoprotein (BSP) (Germany). HITACHI HI Vision Avius ultrasound scanner was used to explore vessels of the soft tissues and the periosteum at the site of regeneration (defect). Results There were no differences in the serum growth factor levels among the participants by gender. Patients of Group II showed 60% reduction in the Ang-2 and VEGF concentration as compared with that in the no-infection group. The serum EGF concentration was 1.6 times higher in individuals suffering from complications of high-energy trauma than in no-infection patients. There were no significant differences in platelet-derived growth factor PDGF-AB, PDGF-BB between the groups. Сhanges in the VEGF concentration were confirmed by the results of Doppler ultrasonography. Conclusion The findings suggest that the VEGFs examined can be additional diagnostic and prognostic markers for the cohort of patients.

Introduction Analysis of the literature and our own data confirm that changes in bone structure in chronic osteomyelitis vary in extension and severity, the boundaries of which are very difficult to determine. Purpose To analyze the extension of the lesion and the depth of bone structure destruction with the method of MSCT in various types of osteomyelitis and variants of its location. Materials and methods The study is retrospective and single-center. The method of polypositional radiography and multislice computed tomography (MSCT) was used to study the features of the X-ray morphology of the femur and tibia with a quantitative assessment of the density of various bone areas in 235 patients with chronic osteomyelitis. Results Chronic osteomyelitis was mostly located in the diaphysis of the femur (33) and tibia (52). Osteomyelitis in all cases was post-traumatic or post-surgical. Fourteen patients had pseudarthrosis or bone defect as a result of a long duration of the disease. Analysis of MSCT data showed that anatomical changes in the femur and tibia in chronic osteomyelitis were individual in all patients. Radiographic morphological manifestations consisted of general symptoms (osteoporosis, osteosclerosis, disorders in architectonics). However, the severity, extension and nature of the structural changes were extremely diverse. The change in bone density featured large deviations. Conclusion The data obtained indicate that the “imaging reality” in the diagnosis of chronic osteomyelitis is computed tomography as it enables to determine the extension and nature of bone changes, to detail various changes in anatomy and architectonics, indicating the “multifaceted character” of chronic osteomyelitis.

Introduction The main reasons for arthroplasty of the ankle joint are osteoarthritis in the terminal stage (posttraumatic or idiopathic), purulent arthritis and oncology. Publications devoted to the problems of infectious complications after arthroplasty of the ankle are not numerous. The rate of periprosthetic ankle infection varies from 2.4 % to 4.7 % of cases; and the predisposing factors include diabetes mellitus, previous history of operations on the joint and the duration of the arthroplasty procedure. The restorative strategy for periprosthetic infection involves diagnostic measures (hematological, radiological, microbiological, radiologic, cytological) and surgical treatment. The variants of surgical treatment of periprosthetic infection of the ankle joint are revision arthroplasty (single- or two-staged), arthrodesis (using external fixation devices and intramedullary nail) and amputation. Moreover, along with surgical intervention, a long-term course of etiotropic therapy (antibacterial and/or antifungal) is mandatory. Methods The result of treatment of a patient with periprosthetic ankle infection using a two-stage arthrodesis procedure was analyzed. Results The medical measures arrested the purulent inflammatory process and enabled the weight-bearing function of the limb. Discussion Two-stage arthrodesis of the ankle may be one of the options for treating periprosthetic infection aimed at maintaining the support function of the limb and its length without the use of additional orthopedic procedures, such as osteotomy for lengthening to cover the post-resection bone defect, thereby reducing the risk of possible complications (damage to the main vessels and nerves in the area of the osteotomy) and the period of surgical rehabilitation of the patient.

Introduction Carcinomatous degeneration is a severe complication of chronic osteomyelitis. The exact mechanism of the malignant transformation remains unknown. This degeneration most often results from squamous cell carcinoma arising in chronic osteomyelitis. Early diagnosis and appropriate treatment are essential for prognosis and final results in carcinomatous degeneration secondary to chronic osteomyelitis. Definitive treatment of chronic osteomyelitis and antimicrobial therapy are thought to be effective in prevention of malignant changes. Objective To identify diagnostic criteria for neoplastic disease in chronic osteomyelitis. Methods We reviewed 7 (2.75 %) patients aged 39 to 65 years who were treated for relapse of bone infection at the Clinic of Osteology Infection between 2017 and 2018. The average duration of the disease was 36 ± 6.42 years. A comprehensive examination performed for the patients on admission included radiographs of the involved limb segment, microbiological analysis of wound discharge, complete blood count, serum biochemistry panels, Doppler ultrasonography of the lower limb arteries and an excisional biopsy. Results Squamous cell carcinoma was diagnosed in the feet of all patients. Discussion The examinations performed were useful for identifying several diagnostic criteria for neoplastic process associated with pseudocarcinomatous hyperplasia in chronic osteomyelitis.

Introduction In the last decade, there has been an increase in the incidence rate of mycoses in patients after injuries and/or operations performed on limb segments and major joints. Mycoses are difficult to diagnose early because the mycotic flora may mimic the bacterial flora being present in the osteomyelitic nidus and primarily identified in the wound exudate. Objective To develop diagnostic criteria for osteomyelitis complicated with mycotic infection. Methods We performed a retrospective study of 28 patients (17 males and 11 females) aged 21 to 76 years (49 ± 16 years) who were treated for purulent inflammatory lesions of bones and/or joints at the clinic of osteology infection between 2000 and 2018. Results Mycotic infection was pathomorphologically detected in the osteomyelitis nidus of all patients. Patients were treated according to the established protocol including radical sequestrectomy, diagnostic biopsy and postoperative administration of antimicrobial and antifungal therapy. Discussion The study allowed identification of several diagnostic criteria for osteomyelitis complicated by mycotic infection. Pathomorphological examination of surgical specimen from purulent inflammatory nidus was shown to be the keystone in diagnosis of osteomyelitis complicated with mycoses.

The article deals with the pin-site infection in transosseous osteosynthesis. Domestic and foreign literature was analyzed; infectious complications were classified and their risk factors, prevention and treatment are discussed

Introduction Results of bacteriological study of the pathological material taken from sinus exits and surgical wounds in 105 patients with implantassociated spinal infection (IAI) who were surgically treated at the bone infection clinic of the RISC for RTO in the period from 2011 to 2017 were analyzed. Purpose Identify the main pathogens of the IAI of the spine. Materials and methods Patients were divided into three groups: group 1 had fistulous forms of peri-implant infection: paravertebral and epidural abscesses and phlegmon (n = 18, subgroup 1); suppuration of soft tissues around metal structures (n = 20, subgroup 2); spondylitis / discitis / osteomyelitis (n = 26, subgroup 3), infectious complications associated with postoperative liquorrhea (n = 5, subgroup 4); group 2 suffered peri-implant infection that developed due to postoperative instability of the metal structure (n = 26); group 3 had infection that developed after implantation of the systems for chronic electrical stimulation (n = 10). Identification of the isolated bacterial cultures was carried out both by the traditional method and by using panels for gram-positive (PBBCS 20) and gram-negative microorganisms (NBC 44) on the WalkAway-40 Plus bacteriological analyzer (Siemens). Results and discussion According to the analysis of the bacteriological results, gram-positive microorganisms (65.7 %) significantly prevailed among the pathogens of implant-associated spinal infection, of which the major ones were staphylococci (52.9 %). Isolation of S. aureus was 34.8 %. Among the methicillin-resistant strains, S. epidermidis was dominant. Among gram-negative microorganisms, both non-fermentative (16.8 %) and enterobacteria (20.9 %) were found. Most frequently identified non-fermenting bacteria were P. aeruginosa and A. baumannii. Enterobacteria were mainly represented by strains of K. pneumoniae and E. coli. Mixed cultures, consisting of two or more microorganisms, were significant. Conclusion Difficulties in the treatment of IAI of the spine require the development of methods for predicting these complications and measures to reduce them. Microbiological monitoring is an integral part of infection control in hospitals, where patients with IAI of the spine are treated. Timely identification of infection pathogens enables to choose correct antibiotic therapy and arrest the infection process in a short time.

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 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 (67 %). 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.

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.

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.

This technique involves removal of implant components, debridement of the purulent focus and installation of a cement spacer which is subsequently replaced with a permanent implant after 3–9 months. Purpose To evaluate mid-term results of two-stage surgical treatment of patients with chronic periprosthetic infection of the knee and hip joints. Materials and methods Treatment outcomes of 172 patients with periprosthetic infection who underwent two-stage revision arthroplasty in the period from 2011 to 2015 were assessed. Among them, 113 patients developed infection after hip replacement and 59 patients had infected knee joint. The average follow-up period was 4 ± 1.58 years (range: 2 to 6 years). Results Out of 113 two-stage procedures of hip joint revision, 102 (90.2 %) cases showed an arrest of infection. Four (3.6 %) patients with recurrence of the purulent process underwent resection arthroplasty, another four (3.6 %) rejected to replace the spacer with an implant, and three (2.6 %) had a two-stage re-revision. Out of 60 (59 patients) procedures of a two-stage knee joint revision, infection was arrested in 50 (83.3 %) cases; eight (13.4 %) had recurrence and underwent knee arthrodesis. One (1.6 %) refused to replace a spacer for an implant, and one more (1.6 %) had a two-stage repeated revision. Conclusions Two-stage knee and hip revision arthroplasty using a cement spacer is an effective option for treatment of chronic periprosthetic infection. It provides infection control in 86.7 % (83.3 % for knee and 90.2 % for hip joints) of cases in the mid-term follow-up period up to 5 years. However, the rate of re-infection remains significant and reaches 13.3 % (9.8 % for hip and 16.7 % for knee joints).

Introduction Infection is a devastating complication after joint arthroplasty. In most cases of purulent infection, surgeons are forced to perform revision of the artificial joint. This is caused by the ability of microorganisms to adhere on the implant surface. Periprosthetic infection is a heavy burden both for patients due to a significant level of the disease recurrence and for medical institutions because of high medical treatment costs. Methods The analysis of the treatment outcome in a female patient with bilateral periprosthetic hip infection was conducted. One- and two-stage revisions were performed. Results The treatment measures stopped the purulent inflammatory process (according to Delphi) and restored the functional state of both hip joints (HHS of 79 points on the left and 93 points on the right side). Discussion Treatment of periprosthetic infection is a complex clinical task, which requires a personalized and comprehensive approach that includes implementation of the basic principles of diagnosis and treatment of the disease, understanding of this pathology, and teamwork. One- and two-stage revisions provide a successful arrest of periprosthetic infection and functional restoration of the affected joint.