METHOD OF SURGICAL TREATMENT OF PATIENTS WITH CHRONIC PERIPROSTHETIC KNEE JOINT INFECTION Russian patent published in 2025 - IPC A61B17/68 A61F2/38 A61N7/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics, and can be used in treating the patients with chronic periprosthetic infection of the knee joint. After removal of endoprosthesis components and surgical treatment of femoral, tibial bones and soft tissues, ultrasonic wound cavitation is performed at frequency 25 kHz, power 90% for 10 minutes in selective mode. Cavitating liquid used is mixture of 10% povidone-iodine 20 ml and 0.9% sodium chloride 500 ml. Method includes selection, fitting and installation of femoral component using bone cement impregnated with antibiotics. Gap is measured between the articulating surface of the installed femoral component and the saw-line of the proximal epiphysis of the tibia in the positions of extension and flexion 90° in a knee joint. Two inserts from high-molecular polyethylene are selected and fitted. In the distal and proximal inserts, four symmetric canals of diameter of 5 mm are drilled medially and lateral in the distal and proximal inserts so that the canal openings closest to the insert edges are spaced 1 cm therefrom. In the distal insert, the canals are formed as through, and in the proximal one – blind, not reaching the articulating surface of insert by 3 mm. Through is also formed in the distal liner, and a comparable blind channel is formed in the proximal liner; blind canals of diameter of 3 mm, depth of 5 mm and pitch of 10 mm are drilled on the side surfaces of the proximal and distal inserts. A through channel is formed in the centre of the distal insert, and a matched blind canal is formed through the proximal insert, which does not reach the articulating surface. Inserts are connected by non-articulated surfaces to each other by means of bone cement impregnated with antibiotics, and fixed to each other by means of screw inserted into oblique channel. Through the distal into the proximal liner, the reinforcing screw is inserted so that it projects from the distal liner. Excess bone cement released through the through canals of the distal liner is simulated in the form of pointed columns 10 mm long and 5 mm in diameter. After polymerisation of the cement is completed, a new portion impregnated with antibiotics is applied on an articulating surface of a distal insert of the spacer, a superior reinforcing screw, on a saw line and on a tibial canal. Spacer is fixed with a superior portion of the reinforcing screw immersed into an intramedullary canal. That is followed by impaction and compression. Stability of components and range of passive movements in a joint are checked up.

EFFECT: method provides restoring the anatomical axis of the lower extremity and range of motions in the joint, stable fixation of the tibial component of the spacer by creating additional depots for the following elution of antibacterial preparations from the bone cement in the surrounding tissues.

1 cl, 2 dwg, 1 ex