The article presents an overview of modern experimental studies devoted to the problem of the treatment of deep surgical infection of the hip joint, as well as an analysis of existing materials used for the manufacture of implants (spacers) of large joints. Purulent inflammation of the hip joint (coxitis) occupies a leading place in the structure of orthopedic diseases. Such inflammation may be the result of iatrogenic infection, complicated fractures, arthritis. There are several classifications of purulent coxitis, which characterize the degree and depth of development of purulent inflammation. Anamnesis and clinical manifestations are the primary criteria for suspected infection in the joint, further diagnosis should be confirmed with the help of basic and secondary diagnostic indicators. Isolation of the pathogen and obtaining a detailed antibiogram together with surgical treatment (arthrotomy with spacer implantation) are crucial for determining a comprehensive strategy for antibiotic therapy of a sick animal. According to most authors, the successful outcome of coxitis is the installation of a temporary implant with an antibiotic. Spacer is a device based on biocompatible materials, such as metal, polymethylmethacrylate, polyethylene, with the inclusion of antimicrobial agents, which is used to temporarily fill the joint cavity. A spacer with an antibiotic helps to fill the space formed after resection, and provides a high local concentration of antimicrobial agents. The advantages of the spacer are a higher elution of antibiotics from the implant surface, the ability to replace a fragment of missing bone in the proximal femur / acetabulum. The use of spacer is considered as an etiotropic and pathogenetic treatment before subsequent endoprosthetics. In the studied literature, only isolated cases of the use of hip joint spacers in animals with purulent coxitis are described.
purulent surgery, inflammation, coxitis, hip joint, antimicrobial therapy, spacer
1. Chernigova S.V., Chernigov S.Yu. Vozmozhnosti lecheniya zhivotnyh s gnoynym koksitom // Aktual'nye problemy veterinarnoy nauki i praktiki: materialy nacional'noy nauch.-prakt. onlayn-konferencii fakul'teta veterinarnoy mediciny IVMiB FGBOU VO Omskiy GAU, Omsk, 13 noyabrya 2020 goda. Omsk: FGBOU VO Omskiy GAU. 2020. S. 46-48. EDN: https://elibrary.ru/FIGCDZ
2. Dochilova E.S., Chernigova S.V., Chernigov Yu.V. Narushenie funkcii oporno-dvigatel'nogo apparata u zhivotnyh na primere veterinarnyh klinik goroda Omska // Omskiy nauchnyy vestnik. 2015. № 2(144). S. 207-209. EDN: https://elibrary.ru/VBCWCB
3. Timofeev S.V., Filippov Yu.I., Koncevaya S.Yu. i dr. Obschaya hirurgiya zhivotnyh: uchebnik dlya studentov vuzov, obuchayuschihsya po special'nosti 111201 "Veterinariya". M.: Zoomedlit. 2007. 687 s. EDN: https://elibrary.ru/QKYHMF
4. Troyanovskaya L.P., Belogurov A.N. Veterinarnaya hirurgiya, ortopediya i oftal'mologiya: ucheb. posobie dlya studentov vysshih uchebnyh zavedeniy, obuchayuschihsya po napravleniyu podgotovki (special'nosti) 111801 - Veterinariya (kvalifikaciya (stepen') "specialist"). Voronezh: Voronezhskiy gosudarstvennyy agrarnyy universitet im. Imperatora Petra I. 2011. 285 s. EDN: https://elibrary.ru/QLDEEB
5. Chernigova S.V., Chernigov Yu.V. Sovremennye principy klassifikacii sepsisa zhivotnyh // Vestnik veterinarii. 2013. № 1(64). S. 47-49. EDN: https://elibrary.ru/PLHJBB
6. Schrader S.C. Septic arthritis and osteomyelitis of the hip in six mature dogs. J Am Vet Med Assoc. 1982;181(9):894-8. PMID: 7141987. PMID: 7141987
7. Savincev A.M., Mal'ko A.V. Vybor operacii endoprotezirovaniya tazobedrennogo sustava pri ankilozah posle gnoynyh zabolevaniy // Izbrannye voprosy hirurgii tazobedrennogo sustava. SPb.: Rossiyskiy ordena Trudovogo Krasnogo Znameni nauchno-issledovatel'skiy institut travmatologii i ortopedii im. R.R. Vredena. 2016. S. 207-212. EDN: https://elibrary.ru/YIURUZ
8. Bezruk E.L. Bakteriologicheskaya harakteristika effektivnosti razlichnyh sposobov drenirovaniya sluchaynyh ran // Vestnik Ul'yanovskoy gosudarstvennoy sel'skohozyaystvennoy akademii. 2020. № 2(50). S. 156-162. EDN: https://elibrary.ru/AXNSCW
9. Ariza J., Euba G., Murillo O. Orthopedic device-related infections. Enferm Infecs Microbiol Clin. 2008;26(6):380-390.
10. Chernigov Yu.V., Chernigova S.V., Chernigov S.Yu. Morfo-funkcional'noe obosnovanie primeneniya cementnyh speyserov pri lechenii zhivotnyh s osteomielitom vertluzhnoy vpadiny (eksperimental'noe issledovanie) // Biotehnologiya: sostoyanie i perspektivy razvitiya: materialy IX Mezhdunar. kongressa, Moskva, 20-22 fevralya 2017 goda. M.: RED GRUPP. 2017. S. 41-42. EDN: https://elibrary.ru/YQOBLD
11. Regis D., Sandri A., Rizzo A., Bartolozzi P. A preformed temporary antibiotic-loaded cement spacer for the treatment of destructive septic hip arthritis: a case report.Int J Infect Dis. 2010 Mar; 14(3):e259-61. PMID: 19664951. DOI:https://doi.org/10.1016/j.ijid.2009.04.019 PMID: 19664951
12. Privol'nev V.V., Rodin A.V., Karakulina E.V. Mestnoe primenenie antibiotikov v lechenii infekciy kostnoy tkani // Klinicheskaya mikrobiologiya i antimikrobnaya himioterapiya. 2012. T. 14. № 2. S. 118-131. EDN: https://elibrary.ru/OYPVHX
13. Cho Y.J., Patel D., Chun Y.S., Shin W.J., Rhyu K.H. Novel Antibiotic-Loaded Cement Femoral Head Spacer for the Treatment of Advanced Pyogenic Arthritis in Adult Hip. J Arthroplasty. 2018;33(6): 1899-1903. PMID: 29361346. DOI:https://doi.org/10.1016/j.arth.2017.12.028 PMID: 29361346
14. Shpinyak S.P., Barabash A.P., Lyasnikova A.V. Ispol'zovanie speyserov pri lechenii infekcionnyh oslozhneniy pri polnoy zamene kolennogo kolesa // Sovremennye problemy nauki i obrazovaniya. 2015. № 5. S. 3. EDN: https://elibrary.ru/YTHXPD
15. Pinsornsak P., Niruktisarn T., Surabotsopon P., Boontanapibul K. Novel molded antibiotic cement spacer: is it better than handmade cement spacer for treatment of chronically infected total hip arthroplasty? Int Orthop. 2022 Aug; 46(8):1693-1700. PMID: 35678842. DOI:https://doi.org/10.1007/s00264-022-05456-4 PMID: 35678842
16. Jones C.W., Selemon N., Nocon A., Bostrom M., Westrich G., Sculco P.K. The Influence of Spacer Design on the Rate of Complications in Two-Stage Revision Hip Arthroplasty. J Arthroplasty. 2019;34(6):1201-1206.https://doi.org/10.1016/j.arth.2019.02. 012. PMID: 30879874. DOI:https://doi.org/10.1016/j.arth.2019.02.012 PMID: 30879874
17. William C.C.H., Simmrat S., Suhaeb A.M. Antibiotic-laden Arthroplasty with a Novel Design of Cement Mould and Metallic Endoskeleton for Treatment of Hip Infection, an Inexpensive Alternative: A Preliminary Report of Two Cases. Malays Orthop J. 2017; №11(2):78-81. DOI:https://doi.org/10.5704/MOJ.1707.015
18. Babushkina I.V., Mamonova I.A., Gladkova E.V. Etiologicheskaya rol' vozbuditeley hronicheskogo osteomielita i vliyanie nanochastic medi na klinicheskie shtammy Staphylococcus aureus // Vestnik Permskogo universiteta. Seriya "Biologiya". 2014. № 2. S. 52-56. EDN: https://elibrary.ru/SICVPF
19. Shevchenko Yu.L., Stoyko Yu.M., Gricyuk A.A. i dr. Lokal'naya antibiotikoprofilaktika pri endoprotezirovanii krupnyh sustavov (literaturnyy obzor) // Vestnik francuzskogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2010. № 3.
20. Belov B.S. Bakterial'nyy (septicheskiy) artrit i infekciya protezirovannogo sustava: sovremennoe sostoyanie problemy // Kachestvo zhizni. Medicina. 2008. № 5. S. 18-23. EDN: https://elibrary.ru/KAZQLR
21. Faschingbauer M., Reichel H., Bieger R., Kappe T. Mechanical complications with one hundred and thirty eight (antibiotic-laden) cement spacers in the treatment of periprosthetic infection after total hip arthroplasty.Int. Orthop. 2015;5:989-994. DOI:https://doi.org/10.1007/s00264-014-2636-z
22. Chernigova S.V., Chernigov Yu.V. Rol' provospalitel'nyh mediatorov v razvitii septicheskih oslozhneniy u zhivotnyh // Veterinarnaya patologiya. 2011. № 1-2(36). S. 92-96. EDN: https://elibrary.ru/NZAUSD
23. Greig J.M., Wood M.J. Staphylococcus lugdunensis vertebral osteomyelitis. Clin. Microbiol. Infect. 2003;11:1139-1141. EDN: https://elibrary.ru/EUCIGH
24. Patent na poleznuyu model' № 201180 U1 Rossiyskaya Federaciya, MPK A61B 17/56, A61F 2/32. Speyser tazobedrennogo sustava: № 2020121570: zayavl. 29.06.2020: opubl. 01.12.2020 / E.O. Perecmanas, T.E. Tyul'kova, V.S. Zubikov i dr.; zayavitel' Federal'noe gosudarstvennoe byudzhetnoe uchrezhdenie "Nacional'nyy medicinskiy issledovatel'skiy centr ftiziopul'monologii i infekcionnyh zabolevaniy" Ministerstva zdravoohraneniya Rossiyskoy Federacii (FGBU "NMIC FPI" Minzdrava Rossii).
25. Videnin V.N. Posleoperacionnye gnoyno-vospalitel'nye oslozhneniya u zhivotnyh (profilaktika i lechenie): ucheb. posobie. SPb.: Lan'. 2000. 160 s. EDN: https://elibrary.ru/VFARZL
26. Patent № 2707734 C1 Rossiyskaya Federaciya, MPK A61K 31/7036, A61F 2/28, A61L 27/54. Antimikrobnaya kompoziciya dlya formirovaniya speysera: № 2019109897: zayavl. 03.04.2019: opubl. 29.11.2019 / A.G. Afinogenova, G.E. Afinogenov, S.A. Linnik [i dr.]; zayavitel' Federal'noe byudzhetnoe uchrezhdenie nauki "Sankt-Peterburgskiy nauchno-issledovatel'skiy institut epidemiologii i mikrobiologii im. Pastera" Federal'noy sluzhby po nadzoru v sfere zaschity prav potrebiteley i blagopoluchiya cheloveka, Federal'noe gosudarstvennoe byudzhetnoe obrazovatel'noe uchrezhdenie vysshego obrazovaniya "Severo-Zapadnyy gosudarstvennyy medicinskiy universitet im. I.I. Mechnikova" Ministerstva zdravoohraneniya Rossiyskoy Federacii, Federal'noe gosudarstvennoe byudzhetnoe obrazovatel'noe uchrezhdenie vysshego obrazovaniya "Sankt-Peterburgskiy gosudarstvennyy universitet". EDN: https://elibrary.ru/ZCKQCJ
27. Patent № 2556622 C2 Rossiyskaya Federaciya, MPK A61B 17/56. Sposob lecheniya gnoynogo artrita: № 2013142978/14: zayavl. 20.09.2013: opubl. 10.07.2015 / I.F. Ahtyamov, H.G. Ismailov, E.B. Gatina i dr. EDN: https://elibrary.ru/THKCWD
28. Lin M., Chang F., Hua M., Wu Y., Liu S. Inhibitory Effects of 1,2,3,4,6-Penta-O-Galloyl-?-d-Glucopyranose on Biofilm Formation by Staphylococcus aureus. Antimicrob. Agents Chemother. 2011;55: 1021-1027.
29. Luther J.F., Cook J.L., Stoll M.R. Arthroscopic exploration and biopsy for diagnosis of septic arthritis and osteomyelitis of the coxofemoral joint in a dog. Vet Comp Orthop Traumatol. 2005;18(1):47-51. PMID: 16594217. PMID: 16594217
30. Komarov R.N., Mitrofanov V.N., Novikov A.V., Korolev S.B. Taktika lecheniya infekcionnyh oslozhneniy posle endoprotezirovaniya tazobedrennogo sustava // Travmatologiya i ortopediya Rossii. 2016. № 22(4). S. 25-34. EDN: https://elibrary.ru/ZTQAZJ
31. Schwaller C.A., Elke R. Cement removal with ultrasound in revision or total hip prosthesis. German. Orthopade. 2001;30;5:310-306. EDN: https://elibrary.ru/ASZHPJ
32. Tihilov R.M., Shapovalov V.M., Shubnyakov I.I. i dr. Rukovodstvo po endoprotezirovaniyu tazobedrennogo sustava; Rossiyskiy nauchno-issledovatel'skiy institut travmatologii i ortopedii im. R.R. Vredena. SPb. 2008. 324 s. EDN: https://elibrary.ru/PVEYVT



