Introduction Limb length discrepancy (LLD) can be debilitating and may cause other medical and social problems. LLD is a serious physical condition and have a significant impact on the patient's quality of life changing the gait, forming pathological adaptive mechanisms and causing long-term musculoskeletal disturbances in children. The objective was to analyze the evolution of tactical approaches to the rehabilitation of patients with lower limb length inequality.Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru) and the National Library of Medicine (www.pubmed.org). Literature searches included both Russian and English studies. The search strategy was comprised of keywords: lower limbs, limb length inequality, approaches and means of limb length correction, osteosynthesis. Clinical guidelines, clinical recommendations, systematic reviews, randomized controlled trials and multicenter cohort studies were selected for analysis.Results and discussion Normal individuals can often experience a difference in the length of the lower limbs from several mm to 1.5 cm and have no effect on the gait, condition of adjacent joints and joints of the opposite limb. Some authors report inequality of 5 mm leading to orthopaedic pathology. A variety of conservative and surgical treatments are offered for limb length equalization. Elimination of LLD is a common and unresolved medical problem. Conservative treatment of LLD can be considered as one of the stages of rehabilitation. Some patients can benefit from conservative treatments. Alternatively, surgical equalization is a treatment option for patients with LLD.Conclusion Surgical methods offered earlier to address LLD had disadvantages, which ultimately minimized their use, and orthopaedic surgeons abandoned some of them due to the high risk of severe complications. The device and the technique developed by Dr. Ilizarov in the 50s of the last century was an epoch-making event in the elimination of LLD and are constantly being improved.

Introduction Total hip arthroplasty (THA) is one of the most successful orthopedic procedures performed today. Rates of THA have been steadily increasing over the past several decades with increasing number of patients who need proper effective rehabilitation therapy after orthopaedic surgery. Evaluation and introduction of new rehabilitation techniques is crucial for patients undergoing replacement of major joints. Objective Review the literature and our own findings with various rehabilitation programs used for THA patients to aid recovery following surgery at a short and long term. Material and methods The study included 57 THA patients referred to rehabilitation department of the Kurgan Ilizarov Center to help manage pain at different terms following surgery. The sample was divided into main (n = 29) and control (n = 28) groups. Post-isometric relaxation techniques were included in rehabilitation program of the main group. Clinical outcomes were evaluated with VAS, the Lequesne Index, McGill Pain Questionnaire, WOMAC, and Harris Hip Score. Results Outcome measures showed 1.5 times improvement in controls with high statistical significance (p > 0.01) and 3.3 times improvement in patients who received post-isometric relaxation therapy with greater significance level (p > 0.001). Conclusion The findings suggest that post-isometric relaxation techniques applied as a part of restorative treatment facilitate improved outcomes of rehabilitation. The optimal rehabilitation protocols have been shown to be largely unknown for THA patients.

Introduction Total hip replacement and total knee replacement are one of the most commonly performed orthopaedic procedures and available assessment tools designed to measure functional outcomes are widely discussed in the literature. Organization and assessment of results of restorative treatment are important issues of total joint arthroplasty. The objective of the study was to evaluate functional status of patients after THR and non-operated subjects with coxarthrosis using scales and tests accepted as quality of life measures. Material and methods Clinical and unctional status (pain intensity, impairment of limb function) was evaluated in 151 THR patients and non-operated coxarthrosis patients using WOMAC, VAS, Harris Hip Score, the Lequesne Index and McGill Pain Questionnaire. Result THR patients showed less pain intensity and stiffness as compared to controls (p < 0.05) with no significant differences in severity of functional disorders before and after THR (p > 0.05). Conclusion The findings suggested that deficits in function in THR patients required rehabilitation interventions at different postoperative time points.

Pain is managed effectively with traditional means of anesthesia with the use of narcotic and non-narcotic medication in tibial correction and lengthening with the Ilizarov method. However, in many cases, traditional analgesics are not sufficient. Therefore, soft tissue manual technique of myofascial release was applied and showed a rather high degree of pain relief

Цель.Изучение динамики морфологических характеристик мышц бедра у больных после эндопротезирования тазобедренного сустава в различных условиях реабилитации.Материалы и методы.Рентгенологическое и ультразвуковое исследование проведено 43 больным с установленным имплантатом тазобедренного сустава и болевыми ощущениями на стороне оперативного вмешательства.Девятнадцати больным (основная группа) амбулаторно был проведен курс мануальной терапии, включавший авторский способ мягкотканной мануальной техники.В контрольную группу вошли 24 пациента в возрасте от 37 до 74 лет (средний возраст 57,3 ± 2,3 года), которые проходили лечение по стандартной методике, включавшей лечебную физкультуру, массаж с ишемической прессурой триггерных точек, физиопроцедуры, нестероидные противовоспалительные препараты, хондропротекторы, сосудистые препараты, витамины группы «В».Результаты.В результате исследования установлено, что изменение оптической плотности мягких тканей бедра после проведения курса мануальной терапии, по-видимому, связано с улучшением двигательной функции сустава, что, в свою очередь, приводит к снижению мышечного тонуса и улучшению микроциркуляции в исследуемой области.После курса мануальной терапии при ультразвуковом исследовании периартикулярных мышц оперированного тазобедренного сустава отмечено увеличение толщины брюшка мышц-мишеней на фоне снижения их эхоплотности и восстановления косопродольной исчерченности.В группе контроля зафиксировано отсутствие изменений анализируемых рентгенологических и сонографических показателей.Заключение.Применение мануальной терапии с целью купирования болевого синдрома у больных после эндопротезирования тазобедренного сустава является достаточно эффективным и может быть включено в комплекс реабилитационных

Purpose. To compare the efficiency of using traditional exercise therapy for coxarthrosis, and the original complex of exercises based on manual therapy soft-tissue techniques.Materials and Methods. A comparative analysis made regarding the efficiency of using traditional exercise therapy for coxarthrosis and after the hip replacement, as well as the original exercise complex based on the soft-tissue techniques of manual therapy. The complex proposed by the authors includes exercises with gravitational loading, postisometric relaxation, relaxing exercises of accelerated rhythm and small amplitude, and it is directed to improving the hip functional state (the decrease of the pain syndrome severity, the increase of range of motion, the increase of tolerance to loads).Results. The results of using the proposed exercise complex in the system of restorative treatment demonstrated its great efficiency comparing to traditional exercise therapy.Conclusion. The proposed exercise complex allows to relieve the suffering of patients with joint pathologies and to improve their quality of life.

Limb amputation leads to many negative medical, psychological, and social consequences, and the phantom-pain syndrome among which plays a leading role both by its incidence, and by the severity of clinical manifestations. The incidence of this pathology development after amputation is evaluated in the range from 44.6 % to 90 %. Relevance of this problem is caused by increasing the number of injured persons in military conflicts, natural disasters, and industrial accidents, as well as by high proportion of occlusion vascular involvements of the lower limbs in the morbidity structure. The disease pathogenesis highlighted in the article, and current approaches to the phantom-pain syndrome diagnosis, treatment and prevention considered.

Purpose. To evaluate the effectiveness of complex conservative treatment of patients with II-III Stage coxarthrosis using different scales and tests. Materials and Methods. 66 patients with II-III Stage coxarthrosis examined. VAS, Lequesne Algofunctional Index, McGill Questionnaire and WOMAC used in the study. The complex of conservative treatment includes the prescription of chondroprotectors, vascular and metabolism-improving preparations, NSAIDs of short course, exposure to ultrasound and laser, exercise therapy with the techniques of gravitational loading and post-isometric relaxation, as well as massage with ischemia-caused compression of trigger points. Results. The study demonstrated that the complex treatment of patients with coxarthrosis decreased pain intensity and changed it emotively, but didn’t lead to significant joint function improvement. Conclusion. The comprehensiveness and continuity of restorative treatment should be observed at all the stages of rehabilitation from the out-patient clinic to rehabilitation department and sanatorium in order to achieve a stable positive effect.

Цель исследования. Оценить зависимость выраженности клинических симптомов от способа фиксации эндопротеза. Материалы и методы. Были протестированы пациенты, прооперированные по поводу коксартроза и предъявлявшие жалобы при контрольных обследованиях (3-12 месяцев после операции). С использованием Визуальной аналоговой шкалы, индекса Лекена, опросника остеоартрита WOMAC, теста Харриса, опросника МакГилла обследован 61 пациент в возрасте от 29 до 78 лет. Была проведена оценка интенсивности болевого синдрома, чувства скованности и функциональных нарушений. Результаты. Полученные данные свидетельствуют об отсутствии влияния особенностей способа фиксации эндопротеза на степень функциональных нарушений и ощущения скованности. Установлено также, что при оценке болевого синдрома в данных условиях наибольшей чувствительностью обладает болевой опросник МакГилла. В процессе исследования обнаружены следующие межгрупповые различия: достоверно менее выраженный болевой синдром в послеоперационном периоде наблюдался у больных, которым проведено эндопротезирование с применением цементной фиксации имплантата (относительно случаев применения бесцементной технологии). Заключение. Проведенные исследования показали, что вариант фиксации компонентов эндопротеза не оказывает влияния на функциональный результат лечения. Межгрупповые отличия имеются только при оценке болевого синдрома. Ключевые слова: эндопротезирование тазобедренного сустава, способы фиксации, боль, тестирование. Purpose. To evaluate the dependence of clinical symptom manifestation on endoprosthesis fixation technique. Materials and Methods. Patients operated for coxarthrosis and complaining during follow-ups (3-12 months after surgery) tested. 61 patients at the age of 29-78 years examined using Visual Analogue Scale, Lequesne index, WOMAC osteoarthritis questionnaire, Harris test, MacGill pain questionnaire. The assessment of pain syndrome intensity, constraint feeling and functional disorders made. Results. The data evidence the absence of the influencing a technique of endoprosthesis fixation on the degree of functional disorders and constraint feeling. MacGill pain questionnaire established to be the most sensitive in case of the pain syndrome evaluation under these conditions. The following differences between groups revealed during the study: significantly less marked pain syndrome observed postoperatively in patients underwent the replacement using cement implant fixation (versus the cases of using cementless technology). Conclusion. The studies demonstrated that a variant of endoprosthesis component fixation didn’t influence the functional result of treatment. The differences between groups noted for the pain syndrome scoring only.

Purpose. To compare the functional status in patients with different etiopathogenetic variants of Stage III coxarthrosis using various rating scales, questionnaires, and tests. Materials and Methods. The results of testing 48 patients at the age of 20-79 years with Stage III coxarthrosis analyzed in order to determine their functional status. The disease primary form identified in 19 patients, dysplastic one – in 14, and secondary form – in 15. Testing performed using Visual Analogue Scale, Leken’s algo-functional index, McGill Pain Questionnaire modified by V.V. Kuz’menko, Harris test, WOMAC questionnaire. Results. Less marked pain and stiffness of movements established to be experienced by persons with secondary coxarthrosis. Female patients determine pain severity higher than male ones. The emotional component dominates for the pain syndrome in women. While, as for “stiffness sensation” criterion, no substantial differences between the two categories of patients observed. Moreover, the distinctions in the manifestation degree of functional disorders depending on gender and the disease duration not revealed. The maximum level of functional disorders observed for the disease primary form, as well as in patients above 50 years old. Conclusion. The assessment complex applied may be recommended for use in orthopaedic clinics to make additional diagnostics of the functional status in patients with different variants of Stage III coxarthrosis. This complex allows analyzing some parameters impracticable to be studied by other clinical techniques, and that is important in the assessment of the performed treatment effectiveness.

Purpose. To evaluate the effectiveness of complex conservative treatment of patients with II-III Stage coxarthrosis using different scales and tests. Materials and Methods. 66 patients with II-III Stage coxarthrosis examined. VAS, Lequesne Algofunctional Index, McGill Questionnaire and WOMAC used in the study. The complex of conservative treatment includes the prescription of chondroprotectors, vascular and metabolism-improving preparations, NSAIDs of short course, exposure to ultrasound and laser, exercise therapy with the techniques of gravitational loading and post-isometric relaxation, as well as massage with ischemia-caused compression of trigger points. Results. The study demonstrated that the complex treatment of patients with coxarthrosis decreased pain intensity and changed it emotively, but didn’t lead to significant joint function improvement. Conclusion. The comprehensiveness and continuity of restorative treatment should be observed at all the stages of rehabilitation from the out-patient clinic to rehabilitation department and sanatorium in order to achieve a stable positive effect.