Mikhail TeplenkyNational Ilizarov Medical Research Center for Traumatology and Orthopaedics, Russian Federation
Title: Possibilities of joint preserving surgery in patients with the developing dysplastic coxarthrosis
Introduction: The significance of pelvic and femoral osteotomies in the condition of developed arthrosis is still disputable. Early osteoarthritis and dis-congruency of the articular surfaces are evaluated by many specialists as contra-indication for the joint preserving operation. Purpose: Review middle term results of reconstructive treatment in adolescents and young adults with dysplastic coxarthrosis
Materials and methods: Treatment outcomes of 35 patients with dysplastic coxarthrosis were analyzed. Mean age at intervention was 16 years (14-32). The grade of arthrosis in joints were assessed according to Tonnis: I – 22, II - 10, III - 3. The type of congruence of articulare surfaces were assessed according to Coleman: I- 12, II-9, III -8, IV – 6. All subjects underwent extraarticulare hip reconstruction with the Ilizarov apparatus included pelvic and femoral osteotomies.
Results: Outcomes were followed from 3 to 12 years. Functional outcomes according to Merle d'Aubigne-Postel were: Pain 4,7±0,1 point. ROM – 4,1±0,2 points. Walking ability – 4,6±0,1 point. Radiographic findings according to Severin were: II? - 20, IIb - 11, III – 4. The congruence of articular surfaces improved in 14 joints, remained unchanged in 20 joints, worsened in one joint. Distribution of joints by type of congruence: I - 18, II-1, III - 14, IV – 2. The grade of arthrosis was unchanged in 25 cases, progressed one grade in 3 joints, reduced in 4 cases. Considering clinical and radiological picture the positive outcomes made up 82%.
Conclusions: Application of reconstructive operations with Ilizarov frame allows to extend fairly the indications for extra-articular reconstructive invasions in dysplastic coxarthrosis. Improved congruence of the articular surfaces in conditions of osteoarthritis in most cases leads to a slowing of progression.
Teplenkii Mihail has graduated Cheliabinsk State Medical Institute and has been working at Russian Ilizarov Scientific Center “RTO” from 1984.In 2004 he became a Head of Pediatric Orthopaedic Department and in 2011 – a Head of the Laboratory for Joint Pathology. He has the highest qualification and the certificate of the specialist on the specialty “Traumatology and Orthopaedics”.He successfully presented the dissertation on “Reconstructive and restorative operations using Ilizarov fixator in children with DDH” for the scientific degree of Doctor of Medical Sciences. Main trend of his work is the congenital and acquired pathology of the large joints in children.4 monographs covering hip pathology were published with co-authors. He published 83 scientific articles and obtained 47 patents on inventions and useful models. He is a member of ATOP, ASAMI, AOLF and SICOT.