Orthopedics - Oleksa A.P. 2006

Joint Diseases
Degenerative-Dystrophic Joint Diseases
Post-inflammatory (Post-infectious) Arthrosis

Post-inflammatory osteoarthritis is a consequence of non-specific acute and chronic, and very rarely specific, joint inflammations accompanied by articular Cartilage destruction and degenerative-proliferative changes across all joint structures. The condition develops insidiously and progresses gradually. In its clinical course and presentation, it is essentially no different from Other forms of deforming osteoarthritis. The choice of Treatment strategy takes into account the patient's age, sex, and occupation, as well as the nature, onset, and progression of the inflammatory process and its flare-ups.

Decisive factors in selecting the treatment method include the clinical manifestations of osteoarthritis and radiological evidence of joint damage. Patients are generally managed in specialized inpatient settings using both conservative and surgical approaches.

Conservative treatment must be pathogenetically justified. The therapeutic regimen must include anti-inflammatory and antibacterial agents. Heat therapy and other modalities that could potentially provoke a flare-up of the infectious process should be avoided.

If conservative management fails and the pain and functional Impairment of the limb become unbearable, surgical intervention is indicated. Arthrodesis, which can be performed via an open or closed technique, is considered the optimal surgical Procedure. Prior to open arthrodesis, preoperative preparation involves administering Antibiotics tailored to the patient's microflora sensitivity, determined by bacteriological cultures from the throat and nasopharynx. The surgical techniques for lower limb arthrodesis were described above.

In the postoperative period, it is crucial to ensure reliable immobilization of the operated limb and to continue Antibiotic therapy for a month, regardless of normal BODY Temperature AND the absence of inflammatory signs. As a rule, two antibiotics are prescribed concurrently and rotated every ten days.

Obviously, closed arthrodesis using a distraction-compression apparatus carries a lower risk of exacerbating the infectious process and is therefore performed without antibiotics. The disadvantage of closed hardware arthrodesis is that the apparatus requires active management and must remain in place for an extended period until fibrous ankylosis, followed by bony ankylosis, is achieved. In some cases, bony ankylosis cannot be attained using this apparatus.

The advantage of this treatment method is that the patient experiences pain relief within days of applying the compression-distraction device, can freely bear weight on the leg, and does not require antibiotic therapy.

No other surgical Procedures are used for post-infectious osteoarthritis. Joint replacement carries the risk of infection recurrence and other complications, although some orthopedic surgeons are willing to take this risk.

Occasionally, deforming osteoarthritis may develop As a result of poorly managed chronic recurrent synovitis following trauma, or chronic synovitis associated with Rheumatoid Polyarthritis characterized by the destruction of articular cartilage. Although the etiopathogenesis of synovitis remains unclear in most cases, its non-bacterial nature is well established. Fibrin from the synovial exudate settles on the synovial lining and articular cartilage surface, impairing its Nutrition.

During joint movement, the fibrin film shifts and accumulates along the edges of the weight-bearing cartilage area, where it undergoes scarring and sometimes ossification, ultimately triggering osteoarthritis. Similar osteoarthritic signs occur in rheumatoid cartilage destruction, leading to joint deformation, pain, and functional impairment of the limb.

To prevent osteoarthritis following chronic synovitis, comprehensive treatment is essential (including aspirations, desensitization therapy, and limb immobilization). Post-rheumatoid osteoarthritis requires surgical intervention. Given the multi-articular involvement and frequent Symmetry of the lesions, patients typically undergo arthroplasty of both Major and minor joints (such as the hip, knee, elbow, and small JOINTS OF THE hand).