rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2017-549-554rsp-2438Research ArticleРЕВМООРТОПЕДИЯ И РЕАБИЛИТАЦИЯORTHOPEDIC RHEUMATOLOGY AND REHABILITATIONМестные осложнения эндопротезирования тазобедренного и коленного суставов у пациентов с ревматоидным артритом и остеоартритомLOCAL COMPLICATIONS OF HIP AND KNEE JOINT REPLACEMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS AND OSTEOARTHRITISХрамовА. Э.KhramovA. E.

Москва, Россия 115522 Москва, Каширское шоссе, 34А

Russia 34A, Kashirskoe Shosse, Moscow 115522

khramov_doctor@mail.ruМакаровМ. А.MakarovM. A.

Москва, Россия 115522 Москва, Каширское шоссе, 34А

Russia 34A, Kashirskoe Shosse, Moscow 115522

МакаровС. А.MakarovS. A.

Москва, Россия 115522 Москва, Каширское шоссе, 34А

Russia 34A, Kashirskoe Shosse, Moscow 115522

БяликЕ. И.ByalikE. I.

Москва, Россия 115522 Москва, Каширское шоссе, 34А

Russia 34A, Kashirskoe Shosse, Moscow 115522

АмирджановаВ. Н.AmirdzhanovaV. N.

Москва, Россия 115522 Москва, Каширское шоссе, 34А

Russia 34A, Kashirskoe Shosse, Moscow 115522

ПавловВ. П.PavlovV. P.

Москва, Россия 115522 Москва, Каширское шоссе, 34А

Russia 34A, Kashirskoe Shosse, Moscow 115522

РыбниковА. В.RybnikovA. V.

Москва, Россия 115522 Москва, Каширское шоссе, 34А

Russia 34A, Kashirskoe Shosse, Moscow 115522

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation201727102017555549554Copyright © Храмов А.Э., Макаров М.А., Макаров С.А., Бялик Е.И., Амирджанова В.Н., Павлов В.П., Рыбников А.В., 20172017Храмов А.Э., Макаров М.А., Макаров С.А., Бялик Е.И., Амирджанова В.Н., Павлов В.П., Рыбников А.В.Khramov A.E., Makarov M.A., Makarov S.A., Byalik E.I., Amirdzhanova V.N., Pavlov V.P., Rybnikov A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2438

Тотальное эндопротезирование суставов (ТЭС) при наличии их выраженной деструкции и артралгий у больных ревматическими заболеваниями (РЗ) является одним из эффективных способов улучшения функционального состояния пациентов и повышения их качества жизни. В последние годы во всем мире возрастает число таких операций на коленных и тазобедренных суставах. Несмотря на достигнутые успехи медицины XXI в., до 5% ТЭС заканчиваются ранними осложнениями, при которых происходят необратимые изменения в суставе, которые обусловливают потерю его функции и сохранение стойких болей, а в 2–3% случаев требуют проведения повторной ранней ревизионной операции.

Материал и методы

Материал и методы. В исследование включено 2142 больных ревматоидным артритом (РА) и остеоартритом (ОА), которым проводилось ТЭС коленных (ТЭКС) и тазобедренных (ТЭТС) суставов в ФГБНУ НИИР им. В.А. Насоновой в период с 1998 по 2016 г.: ТЭТС – 1177 больным и ТЭКС – 965. Пациентам с РА выполнено 467 ТЭТС и 651 ТЭКС (всего 1118 операций). Группу сравнения составили больные ОА, которым проведено 710 ТЭТС и 314 ТЭКС (всего 1024 операции). Послеоперационные хирургические осложнения учитывались в течение 2 лет после проведения операций: поверхностное или глубокое нагноение, вывих сустава, перипротезные переломы, нейропатии седалищного и/или малоберцового нерва, асептическая нестабильность компонентов эндопротеза, осложнения со стороны раны и со стороны связочного аппарата.

Результаты и обсуждение

Результаты и обсуждение. В целом частота местных осложнений при ТЭТС и ТЭКС была сопоставимой и составила 7,22 и 7,25% соответственно (р=0,83), однако их структура существенно различалась: при ТЭТС отмечено большее число перипротезных переломов – 3,48%, по сравнению с 0,93% (р<0,001) при ТЭКС. При ТЭКС отмечались большее число инфекционных осложнений (1,66% по сравнению с 0,27% при ТЭТС; р<0,001) и удлинение времени заживления послеоперационной раны (1,87% по сравнению с 0,42% при ТЭТС; р<0,001). При сравнении частоты местных осложнений у пациентов с РА и ОА при ТЭТС отмечалось ее достоверное увеличение у больных РА (29%) по сравнению с пациентами с ОА (5,21%; р=0,001). В структуре местных осложнений различия были достоверны только в отношении частоты перипротезных переломов (р=0,028) и плохого заживления послеоперационной раны (р=0,019), которая была выше у больных РА. Статистически достоверной разницы в частоте местных осложнений между пациентами с РА и ОА при ТЭКС не было. Таким образом, оперативное лечение пациентов с РА требует особого подхода, который заключается в грамотном периоперационном медикаментозном ведении пациента и бережном обращении с костью и окружающими тканями во время операции.

Total joint replacement (TJR) in the presence of severe joint degradation and arthralgias in patients with rheumatic diseases (RDs) is one of the effective ways to improve the functional status of patients and their quality of life. In recent years, there has been an increase in the number of such knee and hip replacements worldwide. Despite advances in medicine in the 21st century, up to 5% of TJRs culminate in early complications, in which there are irreversible joint changes that cause joint functional loss and persistent pain and, in 2–3% of cases, require early re-revision surgery.

Subjects and methods

Subjects and methods. The investigation included 2142 patients with rheumatoid arthritis (RA) and osteoarthritis (OA) who underwent knee or hip joint replacement (KJR or HJR) at the V.A. Nasonova Research Institute of Rheumatology during the period 1998 to 2016: HJR in 1177 patients and KJR in 965. The patients with RA had 467 HJRs and 651 KJRs (a total of 1118 operations). A comparison group consisted of patients with OA who underwent710 HJRs and 314 KJRs (a total of 1024 operations). Postoperative surgical complications, such as superficial or deep suppuration, joint dislocation, periprosthetic fractures, sciatic and/or peroneal neuropathies, aseptic instability of endoprosthesis components, and complications of wound and ligamentous apparatus, were considered within 2 years after surgery

Results and discussion

Results and discussion. Overall, the frequency of local complications after HJR and KJR was comparable and amounted to 7.22 and 7.25%, respectively (p=0.83), but their pattern greatly differed: there were a larger number of periprosthetic fractures after HJR than after KJR (3.48% and 0.93%; p <0.001). After KJR as compared to HJR, there were a greater number of infectious complications (1.66 and 0.27%; p <0.001) and a longer postoperative wound healing (1.87 and 0.42%; p <0.001). Comparison of the frequency of local complications revealed that there is a significant increase in patients with RA (29%) compared with those with OA (5.21%; p=0.001). The pattern of local complications was characterized by significant differences only in the frequency of periprosthetic fractures (p=0.028) and poor postoperative wound healing (p=0.019), which was higher than that in patients with RA. There was no statistically significant difference in the frequency of local complications after KJR in patients with RA and those with OA. Thus, surgical treatment of patients with RA requires a special approach that includes the competent perioperative medical management of a patient and the careful handling of the bone and surrounding tissues during surgery.

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The authors declare that there are no conflicts of interest present.