The dissertation is devoted to the optimization of knee joint endoprosthesis replacement technology in patients with bone tumors. In the structure of oncological morbidity, primary bone tumors make up 0.7-2.0% of all malignant neoplasms: 0.53% among men and 0.34% among women. Bones forming the knee joint in 60-70% of cases are affected by malignant and benign tumors. Until the 70s of the last century, amputation or exarticulation of the limb was the surgery of choice for tumor lesions of the bones of extremities, but currently 90% of patients with malignant lesions of long bones undergo organ-preserving surgical treatment in the form of segmental resection with endoprosthetics. Endoprosthetics to replace bone defects after tumor removal, in comparison with other reconstructive operations, allows to significantly improve the results of organ-preserving operations, and improve the quality of life of patients. With the growth of surgical activity in favor of organ-preserving operations, the number of complications characteristic of endoprosthetics also increases. Among them, infectious complications (3-13%), and various types of instability of the endoprosthesis and its assemblies and units prevail, which make up from 2% to 10%. When the tumor is localized in the distal femur, after knee joint endoprosthesis replacement, infectious complications occur in an average of 8% of patients, aseptic instability occurs in 10%, and relapses occur in 10%, the total five-year service life of endoprosthesis amounts to about 54%. When the proximal tibia is damaged, after knee joint endoprosthesis replacement, infectious complications occur in 10-16% of patients, aseptic instability occurs in 18%, and relapses occur in 13%, the total five-year service life of the endoprosthesis amounts to about 38%.
Only in 27-30% of patients it is possible to manage to eliminate these complications with conservative measures, including systemic and local administration of antibiotics, active drainage of the wound, removal of implants and bone cement, with the use of one-stage re-endoprosthetics. After knee joint endoprosthesis replacement, mechanical complications are often observed, which arise due to significant traumatization of soft tissues, uneven distribution of the load on the bone, bone necrosis due to mechanical processing, high temperature of cement polymerization, the body's reaction to a foreign body, damage to the friction assembly in the artificial joint, micromobility of the endoprosthesis and its components due to inadequate fixation, which leads to aseptic instability of the endoprosthesis.
Thus, complications after joint endoprosthetics due to bone tumors represent a significant problem that leads to impaired function, and sometimes to the loss of a limb, and significantly worsens the quality of life of patients. Until now, the main factors that influence the occurrence of complications have not been sufficiently determined, and on the basis of these factors, groups of oncological patients for whom endoprosthetics operations are recommended, have not been determined. All this determines the relevance of this problem, and represents the basis for carrying out the planned research.
The purpose of the study: Improving the results of knee joint endoprosthesis replacement in patients with bone tumors by optimizing the technology of surgical treatment of the pathological process.
Objectives of the study:
1.To conduct a retrospective analysis of the results of knee joint endoprosthesis replacement for bone tumors.
2.To determine the factors that affect the occurrence of complications during knee joint endoprosthesis replacement.
3.To improve the technologies of knee joint endoprosthesis replacement in patients with bone tumors.
4.To conduct an analysis of orthopedic and oncological results after knee joint endoprosthesis replacement in patients with bone tumors using endoprosthetics technology.
5.To develop an algorithm for knee joint endoprosthesis replacement surgery in patients with bone tumors.
The design of this study was approved by the Commission on Bioethical Expertise and Research Ethics of the Bogomolets O.O. National Medical University, Protocol No. 126 dated November 13, 2019.
The I-st stage included conducting of a retrospective analysis of endoprosthetics and gathering of material to determine the morphological properties of bone tumors in patients, analysis and statistical processing of research results.
The II-nd stage provided for knee joint endoprosthesis replacement using modular endoprostheses in patients with bone tumors, who were being treated in the departments of the State University "Institute of Traumatology and Orthopedics of the NAMS Ukraine, GOI" for the purpose of research: choosing the method and technique of endoprosthetics
