The Mechanism of Contracture Formation in the Hip and Knee Joints in Early Stages of Rheumatoid Arthritis (Natural Experiment

Бабко, А.М.; Herasymenko, А. S.; Mazevych, V.B.

doi:10.37647/0132-2486-2019-103-4-53-61

Cited by 3 publications

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“…Під час натурного експерименту на незаморожених трупах дорослих людей віком від 55 до 68 років, в анамнезі яких не було захворювань досліджуваних суглобів і обсяг рухів (ОР) був повним, встановлено, що показники внутрішньосуглобового тиску залежать як від просторової орієнтації кісток, що формують КоС, так і від об'єму рідини у порожнині суглоба. Положенням кісток, що зчленують колінний суглоб, при якому спостерігається найменший тиск у суглобі, є положення згинання під кутом 20°, а середній об'єм порожнини колінного суглоба становить 134,013 мл [5].…”

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Total Knee Arthroplasty for Contractures in Patients with Rheumatoid Arthritis

Herasymenko,

Poluliakh,

Babko

et al. 2023

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Summary. Knee joint injury in patients with rheumatoid arthritis (RA) occurs in 70% of cases. This is the most common cause of loss of work capacity and the ability to selfcare; patients become severely disabled, since the disease is accompanied by contractures with the development of discordant positions of the lower limbs, which leads to a partial or complete loss of the function of support and walking. Thus, this problem needs to be studied. Objective: to analyze the orthopedic treatment of secondary arthrosis of the knee joints in patients with RA, complicated by contractures. Materials and Methods. In this study, we have analyzed the orthopedic treatment of 66 RA patients with secondary arthrosis with contractures, who underwent 75 total knee replacements between 2013 and 2020. Anamnestic data, clinical, biomechanical and statistical research methods were used. Results. The analysis of the results of total knee replacement was followed in the period from 6 months to 5 years. The results were evaluated according to the 100-point scale by J. Joseph, E.E. Kaufman (1550). The majority of patients had good treatment results. Conclusions. Total knee replacement is required in patients with 2nd phase of the stage II of the disease and higher. In our opinion, this is the most optimal time for surgical treatment, which allows patients with RA to fully use the capabilities of an implanted endoprosthesis.

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Total Knee Arthroplasty for Contractures in Patients with Rheumatoid Arthritis

Herasymenko,

Poluliakh,

Babko

et al. 2023

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“…Аналіз літературних джерел свідчить про певні проблеми, які виникають після таких операцій [12][13][14]. Тривалість функціонування протеза залежить у першу чергу від відповідності елементів ендопротеза анатомічній будові суглоба, що при РА не супроводжується значною адаптаційною перебудовою кістки та м'яких тканин при навантаженні й рухах та наявністю періартикулярного остеопорозу [15,16].…”

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Particularities of the bone tissue regenerative properties of the proximal part of the tibia in patients with rheumatoid arthritis with multi-plane knee deformities

Gerasymenko,

Poluliah,

Gerasymenko

et al. 2024

PJS

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Background. Rheumatoid arthritis (RA) has no equal among the musculoskeletal system diseases in terms of the severity of joint damage. Knee joint damage was noted in 65–70 % of RA patients and it is the most common cause of disability. The purpose was to study the indices of osteogenic activity of stromal (mesenchymal) stem cells (MSCs) of the articular bone ends of the knee joint in patients with secondary knee osteoarthritis (KOA) due to RA in the presence of multi-plane deformations. Materials and methods. The studied material was samples of cancellous bone of the anterior and posterior parts of the plateau of the proximal part of the tibia and spongiosa from a depth of 1 cm and 3 cm from the articular surface, namely from the proximal epimetaphysis of the tibia, removed during knee arthroplasty of patients with secondary KOA due to RA and in patients with primary KOA in the presence of multi-plane deformations. Using the method of cloning colony-forming units of fibroblasts (CSF) of bone tissues, 38 patients were examined, including 9 patients with RA and 29 patients with primary KOA with damage to the knee joint in the presence of multi-plane deformations. Results. The total number of nucleated cells in 1 cm3 of spongiosa of the front part of the tibial plateau was 2.3 times lower compared to the parameter of this index in the posterior part (p < 0.05). The characteristics of spongy tissue in terms of the number of nucleated cells and the content of CSF in 1 cm3 from a depth of 3 cm from the articular surface of the proximal epimetaphysis of the tibia of patients with RA were almost 3 times higher compared to the indices of patients with primary KOA (p < 0.05). Conclusions. Changes in the renovation processes of bone tissue in patients with secondary KOA due to RA and in patients with primary KOA in the presence of multi-plane deformations are unidirectional, but their expressiveness is greater in patients with RA. At a depth of 3 cm from the articular surface of the proximal epimetaphysis of the tibia, the conditions for secondary fixation of the leg of the knee joint replacement are much better, all other conditions being equal, so the "survival" of the endoprosthesis with an elongated leg will be greater.

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Mathematical model of knee joint degenerative dystrophic changes formation in its flexion contracture at late stages of rheumatoid arthritis

Gerasymenko,

Babko,

Gerasymenko

et al. 2023

PJS

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Background. Rheumatoid arthritis (RA) is an immunomodulatory, chronic inflammatory disease accompanied by the proliferation and articular cartilage destruction that cause disability. Biomechanical factors in RA can play an important role in the onset and progress of the joint degenerative processes, secondary to the inflammation process. The biomechanical factors in RA can play an essential role in the start and progress of the degenerative processes within the joint that are secondary to the inflammatory process. Materials and methods. A solid simulation 3D-model of the knee joint was created that contained both tibia and fibula, the femur bone, femoral condyle cartilage and tibial plateau cartilage, menisci. It was done for further analytical calculations and finite element modeling calculations. Analytical calculations are based on the data of previous studies of quantitative evaluation of the knee joint contracture (compliance of contracture to the external corrective action) and on calculations data of the joint forces that manifest in ambulation of the patient with RA. Results. The created simulation computer 3D-model of a knee joint with its flexion contracture at late stages of RA shows that the forced passive flexion in the knee joint to 6°, the load on the condyles of the tibial plateau increased by 12.8 %, and as a result of forced passive flexion in the knee joint to 3°, the load on the condyles of the tibial plateau increased by 95.2 %, which is critical and may cause degradation of the bone tissue in the contact area. Conclusions. Increase of load on the lateral areas of the tibial plateau and, correspondingly, the tensions on the contact areas of the femur bone condyles with the tibial plateau, may contribute to the progress of the clinical picture of RA with the increase of arthrofibrosis and osteoarthritis events, particularly in the lateral areas of the knee joint.

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The Mechanism of Contracture Formation in the Hip and Knee Joints in Early Stages of Rheumatoid Arthritis (Natural Experiment

Cited by 3 publications

References 0 publications

Total Knee Arthroplasty for Contractures in Patients with Rheumatoid Arthritis

Total Knee Arthroplasty for Contractures in Patients with Rheumatoid Arthritis

Particularities of the bone tissue regenerative properties of the proximal part of the tibia in patients with rheumatoid arthritis with multi-plane knee deformities

Mathematical model of knee joint degenerative dystrophic changes formation in its flexion contracture at late stages of rheumatoid arthritis

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