Impact of comorbidity on the results of total hip and knee replacement in patients with osteoarthritis in spondyloepiphyseal dysplasia

I.V. Guzevskiy, S.I. Gerasimenko, L.M. Panchenko

Abstract


Background. It is known that in patients with osteoarthritis, the level of comorbidities is high: more than 5 diseases are observed in almost half of such patients, that makes it of current interest to study the effect of comorbidities on the results of surgical treatment of this group of patients. Оsteoarthritis due to spondyloepiphyseal dysplasia is considered as а clinical manifestation of connecting tissue dysplasia with a demonstrating failure of the locomotor system. Considering the universality of connective tissue dysplasia when it exists, there is always precondition for the development of pathological changes in many organs, which can affect the outcome after arthroplasty. This study aims to explore the influence of comorbidities on the features of postoperative period and the results of arthroplasty in patients with hip and knee osteoarthritis due to spondyloepiphyseal dysplasia. Materials and methods.
The analysis of the outcomes of total hip and knee replacement was carried out in 57 patients with stage 3–4 osteoarthritis (according to the classification of J.N. Kellgren and J.S. Lawrence, 1957) of the knee and hip joints, which developed against the background of spondyloepiphyseal dysplasia. As the prototype of scoring system in patients, we have elected Charlson Comorbidity Index (Charlson M.E. et al., 1987). In order to adapt this system to this pathology and in view of using a quite traumatic surgical technique associated with implantation of artificial materials, as a comorbidity factors we have taken into account the changes in the general immune status and osteogenic activity of marrow stem stromal cells. As the criteria of the influence on the local features of early postoperative period, there were considered the type of wound healing, the severity of pain and swelling of the limbs within 2 weeks after surgery. The success of endoprosthesis implantation was assessed by clinical and X-ray examination of the operated joint from 1 to 5 years after surgery. Results. It was found that this group of patients has comorbid pathology that hasn’t a decisive impact on the success of total hip and knee replacement. When adapted for this group of patients, comorbidity index of 3 points should predict the development of temporary local complications in up to 20 % of cases. Established essential increase of osteogenic activity of marrow stem stromal cells that comprises threat of an exhaustion of bone tissue remodelling potential in a zone of implant makes unreasonable the delay in arthroplasty of the lower limb joints in patients with osteoarthritis due to spondyloepiphyseal dysplasia. Conclusions. During the preparation to arthroplasty in patients with osteoarthritis of the lower limb joints, which developed against the background of spondyloepiphyseal dysplasia, to prevent complications it is advisable to carry out correction of immune status and use therapeutic measures aimed at improving the local neurotrophic processes in the affected limb.


Keywords


comorbidity; spondyloepiphyseal dysplasia; total hip and knee replacement

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DOI: https://doi.org/10.22141/1608-1706.2.18.2017.102568

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