Introduction Hip joint arthroplasty combined with shortening osteotomy is a technically difficult surgical intervention. Transection of the femur is possible both with the free-hand method and with the use of special devices. Purpose To evaluate the efficiency of using a special device for shortening osteotomy in total hip arthroplasty in comparison with the operations performed without an osteotomy guide. Materials and methods There were 16 hip replacement surgeries that included shortening osteotomy performed in patients with high dislocation of the femur. The group was divided into 2 subgroups: the study subgroup (8 cases), in which a special device was used for osteotomy, and the control subgroup (8 cases). We used clinical and radiographic study methods, and assesssed the Harris Hip Score (HHS) before and after treatment. Results Duration of the intervention and intraoperative blood loss in the first subgroup were shorter than in the control group but the difference was not statistically significant. The mean HHS increased significantly in the whole group. The midterm HHS in the study subgroup was 85.4 ± 1.9 points, which slightly differed from the control (81.9 ± 1.2 points). The mean follow-up period was 40 ± 8 months. There were two cases of nonunion in the osteotomy site and one case of transient sciatic neuropathy. Two patients with nonunion of the femoral fragments were treated by plating and bone grafting. Conclusion The use of a special device for subtrochanteric osteotomy technically simplifies the arthroplasty procedure in patients with high dislocation of the femur, shortens the operation time and reduces blood loss.

The purpose of the study was to evaluate specific features of spine sagittal balance in patients with coxarthrosis of different etiology before and after total hip replacement (THR). Materials and methods Clinical and radiographic evaluation was performed for 46 patients admitted for primary THR. The patients were diagnosed with dysplastic (n = 14), degenerative (n = 26) and posttraumatic (n = 6) coxarthrosis and evaluated preoperatively, on the 7th day postsurgery and at a long-term follow-up. Spinopelvic parameters of sagittal balance, stages of osteoarthritis and cranial displacement of femoral heads according to Crowe were assessed. Clinical evaluation included physical examination, hip function with the Harris Hip Score (HHS), range of motion in the involved hip, relative limb shortening, neurological status, Oswestry questionnaire (ODI) and spinal pain syndrome using the Wong-Baker Faces Pain Rating Scale (2011). A statistical software package of Microsoft Office Excel 2016 was applied for data analysis. Statistical analysis of variance was used to calculate the arithmetic mean (M), error of the arithmetic mean (± m), the Pearson correlation coefficient r and estimate using the Chaddock scale. The Student’s t-test was used to confirm significant differences in the means identifying a significance level. Results and discussion Comparative analysis of spinopelvic parameters showed decreased PT and SS with increased LL in patients with dysplastic coxarthrosis. No considerable changes of spinopelvic parameters were revealed in patients with degenerative coxarthrosis. Marked limitations in ROM were seen in patients with dysplastic coxarthrosis. A moderate correlation between ROM of the involved hip and spinopelvic parameters was observed in dysplastic coxarthrosis. No correlation was detected between spinopelvic balance and spinal pain syndrome. Conclusion No significant differences in spinopelvic parameters were noted in patients with hip-spine syndrome associated with degeneration. Dysplastic changes can be a predisposing factor for spinopelvic imbalance in THR. Correlation analysis showed that combined joint contracture was involved into the biomechanical aspect of spinopelvic imbalance in dysplastic coxarthrosis. As reported by other researchers, total hip replacement with good functional outcome was not shown to result in significant changes in spinopelvic alignment.

Total hip replacement (THR) in patients with a high congenital dislocation of the hip (crowe type IV dysplasia in crowe classification) is a technically difficult operation, associated with a high risk of complications. The most common variations of THRs used to restore the true center of rotation of the hip are subtrochanteric shortening osteotomy and proximal shortening osteotomy using the Paavilainen technique. Numerous publications refer to the technique and outcomes of subtrochanteric osteotomy, but fundamental differences of opinion persist on a number of points relating to the topic. The objective of the study is to analyze the publications on the treatment for crowe type IV hip dislocations using total replacement of the hip joint (Hj) with subtrochanteric shortening osteotomy. The hypothesis of the study was as follows: the method of fixation of the femoral component, the type of osteotomy and the design features of the implant (philosophy) are the factors that determine the effectiveness of the operation. The electronic databases elibrary and PubMed were searched for publications containing keywords in Russian or english: high dislocation of the hip, total replacement of the Hj, shortening subtrochanteric osteotomy. as a result of the study, the proposed hypothesis was partially confirmed. There were only minor differences in the overall incidence of complications and the survivorship of implants when using different types of cementless stems. The incidence of non-unions after the installation of cemented femoral components was higher than with the implantation of cementless. We did not find convincing evidence of the advantage of the step-cut, V-shaped and oblique osteotomies compared with the transverse osteotomy. Typical complications for such operations were the nerve injuries, intraoperative hip fractures, dislocations and non-unions of the femur at the osteotomy site.

Acetabular fractures are often complex injuries and the result of high-energy trauma increasing in recent years with the increased use of high-speed motor vehicles. Acetabular fractures account for 7 to 25 % of all pelvic injuries and are associated with significant morbidity. The complex nature of these fractures requires multi-staged treatment with the usage of various methods of osteosynthesis, their combination including primary reconstructive joint replacement. In spite of the improved techniques and new technologies rehabilitation of the patients is a particularly challenging problem. Material and methods Literature searches were performed on several databases: PubMed, Scopus, еLibrary.ru and others. Search keywords included “acetabular injury”, “consequences of acetabular fracture”, “acetabular osteosynthesis”, “total hip replacement”, “nonunion of acetabulum”, “hip arthroplasty in patients with consequences of acetabular injury”. Objective To do analytical review on the subject “Treatment of consequences of acetabular injuries”. Conclusion Types of acetabular injuries and methods of treatment are described in the available literature. Nevertheless, the findings showed no systemic approach to rehabilitation of the patients and there is a need to improve the existing practice and devise new techniques and algorithms of treatment.

The objective of the study was to evaluate cytokine concentration and profile of lipid peroxidation in synovial fluid of patients with osteoarthritis and concomitant defects of articular surfaces. Material and methods Synovial fluid samples were taken from 102 patients with osteoarthritis of the knee joint. Patients with rheumatoid arthritis, osteoarthritis of a post-traumatic etiology, and somatic diseases that could affect results of the study were excluded from the study. Thirty control samples originated from deceased donors of both genders. Synovial fluid was extracted in compliance with Ministry of Health Order No. 694 dtd July 21, 1978, p. 2.24 "Guidelines of forensic medical examination in the USSR". Results Findings of laboratory studies showed statistically significant differences in synovial fluid cytokine levels depending on absence or presence of defects on the tibial condyles. Biochemical tests revealed greater changes in lipid peroxidation in patients with articular defects. Total level of lipid peroxidation products resulting in the formation of conjugated dienes (CD), malondialdehyde (MDA) was shown to increase in both groups of patients being significantly higher in patients with defects on articular surfaces. Primary (conjugated dienes) and secondary (malondialdehyde) lipid peroxidation products accumulated in the synovial fluid of the patients with the levels being significantly increased in both groups with no changes in the CD/MDA ratio. Patients with defects on articular surfaces demonstrated increased formation of primary products, and non-defect group showed greater formation of secondary products. Antioxidant enzyme, catalase, appeared to me more active in patients of Group I. Conclusion The findings can be used to evaluate defects on articular surface and identify strategies of medication therapy.

There are a fair number of papers presenting the outcomes of total hip arthroplasty with shortening subtrochanteric osteotomy in neglected hip dislocation. In most of them the authors used long modular stems or Wagner stems as a femoral component. The reports describing the outcomes of such procedures with standard femoral stems are rather rare.The purpose of this study was to evaluate short-term and medium-term outcomes of total hip arthroplasty with standard femoral stems and shortening subtrochanteric osteotomy for treatment of high hip dislocation.Materials and methods. From 2010 to 2016 the authors performed 18 hip arthroplasties with shortening subtrochanteric osteotomy in 16 patients with high hip dislocation. All patients were clinically evaluated using Harris Hip Score and radiography prior to and after the surgery.Results. The mean Harris Hip Score significantly improved compared to preoperative values from 39.7±1.4 to 84.7±1.6. At mean follow-up of 24±2.4 mounts the authors observed 2 case of nonunion at osteotomy site and 1 case of transient nerve palsy. Revision surgery was performed in 2 patients due to nonunion. The mean limb lengthening was 3.65±0.21 cm.Conclusion. Our data demonstrated that total hip arthroplasty with subtrochanteric osteotomy is an effective technique for treatment of Crowe type III-IV congenital hipdislocation with high rate of successful fixation on the typical femoral stem, healing of osteotomy site and satisfactory shortand medium-term clinical outcomes. The non-modular tapered stem provides sufficient stability in distal and proximal parts of the femur. The use of standard tapered stem allows to achieve good healing rates of the osteotomy.

Представлен клинический случай, демонстрирующий результат эндопротезирования тазобедренного сустава у пациентки 32 лет с последствиями повреждений вертлужной впадины.На момент поступления рентгенологически определялось состояние после оперативного лечения, вывих головки левой бедренной кости, нарушение формы тазового кольца, деформация и несросшийся перелом дна вертлужной впадины.Укорочение левой нижней конечности -5см.Объем движений в левом тазобедренном суставе резко ограничен.На первом этапе выполнена корригирующая остеотомия через зону псевдоартроза, репозиция отломков, стабилизация передней колонны мостовидной предварительно изогнутой пластиной

There are a fair number of papers presenting the outcomes of total hip arthroplasty with shortening subtrochanteric osteotomy in neglected hip dislocation. In most of them the authors used long modular stems or Wagner stems as a femoral component. The reports describing the outcomes of such procedures with standard femoral stems are rather rare. The purpose of this study was to evaluate short-term and medium-term outcomes of total hip arthroplasty with standard femoral stems and shortening subtrochanteric osteotomy for treatment of high hip dislocation. Materials and methods. From 2010 to 2016 the authors performed 18 hip arthroplasties with shortening subtrochanteric osteotomy in 16 patients with high hip dislocation. All patients were clinically evaluated using Harris Hip Score and radiography prior to and after the surgery. Results. The mean Harris Hip Score significantly improved compared to preoperative values from 39.7±1.4 to 84.7±1.6. At mean follow-up of 24±2.4 mounts the authors observed 2 case of nonunion at osteotomy site and 1 case of transient nerve palsy. Revision surgery was performed in 2 patients due to nonunion. The mean limb lengthening was 3.65±0.21 cm. Conclusion. Our data demonstrated that total hip arthroplasty with subtrochanteric osteotomy is an effective technique for treatment of Crowe type III-IV congenital hipdislocation with high rate of successful fixation on the typical femoral stem, healing of osteotomy site and satisfactory shortand medium-term clinical outcomes. The non-modular tapered stem provides sufficient stability in distal and proximal parts of the femur. The use of standard tapered stem allows to achieve good healing rates of the osteotomy.

Introduction. Reconstructive arthroplasty of the hip in patients with coxarthrosis accompanied by femoral deformity is a difficult and relevant problem. The issues related to the definition and classification of femoral deformity, the reconstruction optimal amount and the type of femoral component fixation are still open. Purpose. To analyze the available data about the hip arthroplasty in patients with femoral deformity in terms of the reconstruction optimal amount and the type of femoral component fixation. Materials and Methods. The literature search made in various information systems (PubMed, MedLine, Scopus, Library.ru, State Public Scientific and Technical Library /GNTB/, Central Scientific and Technical Library /TsNTB/, and others) using the terms: “femoral deformity”; “total hip arthroplasty after previous osteotomy”; “the hip arthroplasty in patients with coxarthrosis accompanied by femoral deformity”; “femoral osteotomy”. Conclusions. There is no generally accepted definition of the concept of the femoral deformity and its classification in literature at present.

The primary purpose of this study was to assess the functional state of different muscles of the lower limb in patients with hip osteoarthritis (OA) combined with femoral deformity due to previous osteotomy. We measured the muscle strength of 20 patients before total hip arthroplasty (THA). All patients were examined on the handheld dynamometers. The absolute peak force of the lower limb muscles was measured. The relative peak force was calculated taking person’s weight into account. We found that the absolute and relative peak force in an OA limb was significantly decreased as compared with a healthy limb. Flexors and extensors of the knee, flexors of the foot were the most deficient. However, weakness of abductor and adductor muscles was less reduced than the weakness of other muscles. Therefore, our results showed that femoral deformity (due to previous osteotomy) has an effect on the abductor and adductor force.

Введение.Реконструктивное эндопротезирование тазобедренного сустава у больных коксартрозом с деформацией бедренной кости является сложной и актуальной проблемой.Вопросы, касающиеся определения и классификации деформации бедренной кости, оптимального объема реконструкции и типа фиксации бедренного компонента, по-прежнему, остаются открытыми.Цель

The result of the hip replacement presented in a female patient with coxarthrosis in the presence of the deformity of proximal femurs after the osteotomies made before. The analysis of functional state during preoperative preparation allowed studying the characteristics of the locomotor system adaptation, as well as determining the sequence with the need to perform reconstructive replacement of the left hip at this stage. This approach allowed obtaining a positive result of treatment.

The result of the hip replacement presented in a female patient with coxarthrosis in the presence of the deformity of proximal femurs after the osteotomies made before. The analysis of functional state during preoperative preparation allowed studying the characteristics of the locomotor system adaptation, as well as determining the sequence with the need to perform reconstructive replacement of the left hip at this stage. This approach allowed obtaining a positive result of treatment.

A case report is presented which demonstrates the result of the combined pathology of lumbar spine and the hip for surgical treatment of articular and vertebrogenic factors. Complex sophisticated differential diagnostics is required at the stage of preoperative preparation in treatment of patients with the hip-spine syndrome in order to determine a dominant factor in the formation of the hip-spine syndrome clinical picture, as well as prioritization and feasibility of performing surgical treatment in one of the hip-spine syndrome components.