Introduction Periprosthetic infection (PPI) is a serious challenge for orthopedic surgeons. Two-stage revision with an antibiotic-impregnated spacer is one of the most common methods for treating periprosthetic infection. Purpose To evaluate the functional results of the second stage of revision arthroplasty in patients with PPI and to determine the survival of the endoprosthesis components. Materials and methods We retrospectively studied the results of the second stage of treatment (removal of the spacer and installation of the endoprosthesis) in 23 patients admitted to the department for the period 2016–2019. All patients received a spacer during the first stage of treatment. The mean age of the patients was 53.7 ± 2.2 years. Males prevailed (91.3 %). Results Three patients developed infection recurrence in the follow-up period of 44.4 ± 1.9 months. The effectiveness of revision arthroplasty performed as the second stage of treatment was 87 %. The Harris Hip Score before the second examination was 42.3 ± 2.5 points, at the time of the last follow-up examination it was significantly higher, 78.32 ± 3.8 points (p = 0.000052; Z – 4.04). Discussion The success of two-stage revision arthroplasty is influenced by the factors associated with patients’ co-morbidities, pathogenicity of the pathogen identified at the first stage, as well as the features of the implants used and surgical tactics. Conclusion The second stage of revision arthroplasty in patients who received a spacer with an antibiotic for the treatment of periprosthetic infection at the first stage significantly improved their functional state. The Kaplan-Meier implant survival rate was 77.5 %.

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.

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.

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.

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.

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

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.

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.

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.

The work demonstrates the results of treatment of male patient Shch., 69 years old, with the diagnosis: posttraumatic pseudoarthrosis of the left femur neck, the pain syndrome, combined contracture of the hip, relative 7-cm shortening of the left lower limb, local osteoporosis. At the first stage, a device mounted from the Ilizarov fixator parts was applied in order to equalize the limb length using distraction by 2-3 mm per day for 17 days. At the second stage, total hybrid arthroplasty of the left hip was performed using the Ceraver prosthesis 3 days after the Ilizarov fixator dismounting. One year later the achieved anatomic-and-functional result of treatment is preserved.

The work demonstrates the results of treatment of female patient B., 61 years old, with the diagnosis: posttraumatic pseudoarthrosis of the left femur neck, the pain syndrome, combined contracture of the hip, relative 4.7-cm shortening of the left lower limb, local osteoporosis. She underwent arthroplasty of the left hip using the DePuy prosthesis with cementless fixation. Due to the pathology complexity the mobilization of the capsule-and-ligamentous apparatus was additionally performed in the area of the greater and lesser trochanters up to the attachment sites of the muscles forming the hip. A good anatomic-and-functional result was obtained.

40 patients with the knee and the hip osteoarthrosis (OA) have been examined in order to study neutrophil functional-metabolic activity when preparing to perform arthroplasty procedure and in case of the development of aseptic artificial joint instability. According to the data obtained, the intensification of neutrophil functional-metabolic activity is observed in both groups, oxygen-dependent metabolism of neutrophil phagocytes begins to dominate for the development of aseptic endoprosthesis instability through phagocytosis activation and enhancement of phagocytic digesting function. Therefore, in the long-term periods after large joint arthroplasty the following parameters of neutrophil phagocytic activity become the most significant diagnostically: PI (phagocytic index), PN (phagocytic number), IPC (index of phagocytosis completeness), НСТ-test, CP (cation proteins).

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.