vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"10.29235/1814-6023-2021-18-2-160-168vestim-757Research ArticleКЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАCLINICAL AND EXPERIMENTAL MEDICINEПричины послеоперационных передних болей при тотальном эндопротезировании коленного суставаAnterior knee pain causes after total knee arthroplastyЭйсмонтО. Л.EismontO. L.

Эйсмонт Олег Леонидович ‒ д-р мед. наук, доцент, заместитель директора по научной работе

ул. Кижеватова, 60/4, 220024, г. Минск

Oleg L. Eismont ‒ D. Sc. (Med.), Associate Professor, Deputy director of scientific work

60/4, Kizhevatov Str., 220024, Minsk 

oleismont@tut.byРеспубликанский научно-практический центр травматологии и ортопедииRepublican Scientific and Practical Centre for Traumatology and Orthopedics202104062021182160168Copyright © Эйсмонт О.Л., 20212021Эйсмонт О.Л.Eismont O.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/757

Цель исследования ‒ определить причины послеоперационной передней боли после выполнения тотального эндопротезирования коленного сустава для профилактики их возникновения и улучшения результатов операций.Проанализированы результаты лечения 77 пациентов (112 случаев), у которых в ГУ «Республиканский научно-практический центр травматологии и ортопедии» была выполнена операция без эндопротезирования надколенника. Использованы тотальные несвязанные эндопротезы коленного сустава с сохранением задней крестообразной связки. В исследованиях приняли участие 62 (80,5 %) женщины и 15 (19,5 %) мужчин. Средний возраст пациентов (Me (25‒75 %)) составил 65 (60‒70) лет. С варусной деформацией коленного сустава было 97 (87 %) случаев, с вальгусной деформацией – 15 (13 %). При этом средний угол варусной деформации составил 11,22 ± 3,81°, средний угол вальгусной деформации – 11 ± 4,27°. Обследование пациентов проводилось при появлении болей через 2‒3, 4‒5 и 6‒7 мес. после операции с использованием клинического, рентгенографического (переднезадняя, боковая и аксиальная проекции, топограмма нижних конечностей), электромиографического, статистического методов.Причинами передних послеоперационных болей являлись: нарушение установки компонентов эндопротеза и микроциркуляции надколенника (хондролиз, аваскулярный некроз надколенника вследствие циркулярной денервации надколенника), дисбаланс в пателлофеморальном суставе, а также функциональные причины передней боли. Боли проявлялись при активной нагрузке на ногу, восстановлении объема движений в колене и силы мышц бедра: при нарушении установки компонентов эндопротеза ‒ в сроки 2‒3 мес. (34 (94 %) случая) и 4‒5 мес. (2 (6 %)); при нарушении микроциркуляции надколенника ‒ в сроки 4‒5 мес. (5 (21 %)) и 6‒7 мес. (19 (79 %)); при дисбалансе в пателлофеморальном суставе ‒ в сроки 2‒3 мес. (29 (69 %)) и 4‒5 мес. (13 (31 %)); при функциональных причинах боли ‒ в сроки 2‒3 мес. (7 (70 %)) и 4‒5 мес. (3 (30 %)).Установлено, что причинами послеоперационных передних болей при тотальном эндопротезировании коленного сустава может быть как непосредственно нарушение техники оперативного лечения, так и изменения в кровоснабжении надколенника или в биомеханике пателлефеморального сустава вследствие дисбаланса мышц бедра.

The objective of the study was to determine the causes of postoperative anterior knee pain after total knee arthroplasty for preventing its occurrence and improving the surgery results.The treatment results of 77 (112 cases) patients with cruciate-retaining total knee arthroplasty without patellar replacement were analyzed. The study involved 62 (80.5 %) women and 15 (19.5 %) men. The average age (Me (25‒75 %)) of the patients was 65 (60‒70) years. There were 97 cases (87 %) with varus deformity of the knee joint, 15 cases with valgus deformity (13 %). The average angle of varus deformity was 11.22 ± 3.81°, the average angle of valgus deformity was 11 ± 4.27°. After the anterior pain appeared, patients were examined in 2‒3, 4‒5 and 6‒7 months after surgery using clinical, X-ray (anterior-posterior, lateral and axial projections, topogram of lower extremities), and EMG methods.The causes of anterior postoperative knee pain were: implant components misplacement, patellar microcirculation disorders (chondrolysis, avascular necrosis due to circular patella denervation), patellofemoral joint imbalance, and functional causes. Pain manifested itself at active leg loading and knee motion because of implant components misplacement within 2‒3 months in 34 cases (94 %), 4‒5 months ‒ in 2 cases (6 %). Patellar microcirculation disorders within 4‒5 months ‒ in 5 cases (21 %), 6‒7 months ‒ in 19 (79 %) cases. Imbalance in the patellofemoral joint within 2‒3 months ‒ in 29 cases (69 %), 4‒5 months ‒ in 13 cases (31 %). Functional causes of pain appeared within 2‒3 months ‒ in 7 cases (70 %), 4‒5 months ‒ in 3 cases (30 %).The causes of postoperative anterior pain in total knee arthroplasty can be incorrect surgical technique, changes in patellar blood supply or in the biomechanics of the patellofemoral joint due to the imbalance of the thigh muscles.

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