Arthrosis of the knee joint is one of the most common diseases in elderly patients with varus deformity. The main organ-preserving method of treatment is corrective osteotomy. The aim of the study was to optimize the technique for correcting varus deformity in patients with gonathrosm based on the Ilizarov method. 39 patients were under observation, who underwent 79 operations. In all cases, it was possible to achieve normalization of the position of the mechanical axis and the angle of orientation of the knee joint. The fixation time with Ilizarov apparatus was 16.6 ± 3.1 weeks. Analyzed complications, outlined measures for their prevention.

Among the many different factors underlying deforming arthrosis, inadequate load on the internal sections of the knee joint in patients with periarticular varus deformities should be highlighted. The term "deforming arthrosis" itself indicates deformity as an important component of the problem. Corrective osteotomy is aimed at normalizing the angular relationships of the bones that form the joint, and as a result, at optimizing the distribution of loads. In fact, osteotomy affects the main link in pathogenesis, which allows you to save the resource of the joint and avoid or postpone joint replacement. Currently, technologies based on submersible and external osteosynthesis are most widely used.

The aim of the study was to optimize the technique for correcting varus deformity in patients with gonathrosis based on the Ilizarov method. Under observation were 39 patients aged 37 to 72 years with bilateral varus deformity and stage II–IV gonarthrosis, who underwent operations simultaneously on both limbs. In all cases, the main diagnostic method was radiography of the lower extremities along the entire length.

All patients achieved normal position of the mechanical axis of the lower limb (32 ± 11 before surgery and 5 ± 3 mm after) and knee joint orientation angles (76 ± 5° before and 89 ± 4° after correction). The period of fixation with Ilizarov apparatus was 16.6 ± 3.1 weeks (min 12.9, max 20.4). During the follow-up period, two types of complications were noted — deep vein thrombosis in 1 (2.6%) patient and inflammation at the exit points of the pins and rods of the Ilizarov apparatus in 23 (29.5%) segments. At the same time, it should be taken into account that inflammation of soft tissues is the most common complication when using external osteosynthesis, belongs to the category of lungs and does not affect the outcome of treatment, but significantly reduces the quality of life, especially in elderly obese patients.

Osteosynthesis of the lower leg with the Ilizarov apparatus in this category of patients is a planned intervention on intact tissues. This greatly facilitates the procedure for applying the device, allows you to determine in advance the level and direction of the introduction of wires and rods, screws, which reduces the time of the operation and virtually eliminates the risk of intraoperative complications. The duration of intervention on both legs averaged 126 ± 18 min. (min 96, max 162), including the application of Ilizarov devices and osteotomies.

The uniqueness of the Ilizarov method lies in the possibility of manipulating bone fragments after surgery in accordance with the specified requirements. Two correction options were used - one-stage and gradual. The advantage of one-stage correction is that it is performed during the operation under anesthesia and is easily tolerated by patients. That is why this option was used in elderly patients who were more difficult to bear the difficulties of the postoperative period associated with the presence of an external fixator. There were no objective advantages of simultaneous or gradual reposition affecting the terms of union or rehabilitation. In the postoperative period, a two-level correction control was used: the first level was a visual assessment of the appearance of the limbs, the second was the assessment of reference lines and angles according to radiographs taken during fixation before the onset of final consolidation.

Thus, the Ilizarov method in the treatment of patients with varus deformity of the lower extremities in combination with gonarthrosis is a high-tech surgical intervention aimed at normalizing the mutual position of the femur and tibia and, as a result, providing optimal loads on various parts of the knee joint. The advantages of the method are accurate correction, stable fixation, which allows to operate on both legs at once, and the absence of foreign bodies after completion of treatment. These advantages make the method attractive for wider use in this category of orthopedic patients.