Hip replacement in case of false joint of the femoral neck with a high dislocation of the hip and severe stiffness soft tissue component. A case from practice

The results of the treatment of the patient A., 57 years of age, with a diagnosis of post-traumatic pseudarthrosis of neck of right femur. Combined contracture of the hip joint, shortening of the right lower extremity 6.5 santimeters, local osteoporosis. In the process of treatment the patient was applied the llizarov apparatus to equalize the limb length, by gradual distraction dosed daily for 39 days. The second stage, 3 days after removal of the llizarov apparatus, made a total hip replacement. After 1 year achieved anatomical and functional result of treatment is maintained.Приведены результаты лечения пациента А., 57 лет, с диагнозом: посттравматический псевдоартроз шейки правой бедренной кости, болевой синдром, комбинированная контрактура тазобедренного сустава, относительное укорочение правой нижней конечности 6,5 сантиметров, локальный остеопороз. В процессе лечения больному был наложен аппарат Илизарова для уравнивания длины конечностей посредством постепенной дозированной дистракции сутки в течение 39 дней. Вторым этапом, через 3 дня после демонтажа аппарата Илизарова, выполнено тотальное эндопротезирование правого тазобедренного сустава. Через 1 год достигнутый анатомо-функциональный результат лечения сохраняется

Biochemical changes of synovial fluid in patients with osteoporosis of knee joint of various etiology

The aim of this study was to perform comparative analysis of biochemical composition of synovial fluid in patients with osteoarthrosis of various etiology. Studies were conducted on samples of synovial fluid of patients which were divided into two groups. Thefirstgroup consisted of 16 patients with patellofemoral arthrosis of the 2nd stage, the second group included 54 patients with bilateral gonarthrosis. The samples of synovial fluid of 11 cadavers of suddenly dead people of both sexes (4 men and 7 women) of 23-79 years who didn't have articular pathology registered by an expert were considered as a norm. Conducted study testifies significant imbalance of prooxidant and antioxidant processes in the synovial fluid and development of oxidative stress the intensity of which depends on the severity of the pathological process but is regardless to its etiology

Evaluation parameters emg muscles of the lower extremities after HIP arthroplasty

Studied the functional state of the lower extremities muscles in patients with stage III coxarthrosis before hip replacement surgery and up to 1 year after. Revealed that the recovery of function in different muscle groups of the lower extremities after surgery is not the same. Overall, in the first few months after surgery, there is a decrease activity of most muscles. In terms of over one year, the amplitude of the bioelectric activity of the m. gastrocnemius lateralis, m. rectus femoris, m. biceps femoris, m. gluteus medius is returned to its original level and m. tibialis anterior and m. gluteus maximus above the original. Additionally these parameters are investigated in patients with aseptic loosening of the endoprosthesis, and in patients with stable prostheses. Revealed that patients with aseptic instability also have reduced amplitude EMG and bilaterally. After reoperation these indicators come back to initial level.Исследовано функциональное состояние мышц нижних конечностей у пациентов с коксартрозом III стадии до операции зндопротезирования тазобедренного сустава и в сроки до 1 года после нее. Выявлено, что восстановление функции разных групп мышц нижних конечностей после операции происходит неодинаково. В целом в первые несколько месяцев после операции отмечается снижение активности большинства мышц. В сроки более 1 года амплитуда биоэлектрической активности m. gastrocnemius lateralis, т . rectus femoris, т . biceps femoris, m. gluteus medius возвращается к исходному уровню, a m. tibialis anterior и т . gluteus maximus превышает исходный уровень. Дополнительно исследовались эти показатели у пациентов с асептической нестабильностью эндопротеза и у пациентов со стабильными протезами. Выявлено, что при асептической нестабильности также отмечается снижение амплитуды ЭМГ, причем билатерально. После операции реэндопротезирования эти показатели возвращаются к исходному уровню

Changes of biochemical parameters of blood serum and daily urine in patients with aseptic loosening of hip endoprosthesis

In order to study metabolic abnormalities in aseptic loosening of hip endoprosthesis performed biochemical analysis of blood serum and daily urine in 31 patients. Statistically significant changes in local and systemic metabolism are revealed, which are in the growth of osteolytic processes, hypoxia, antioxidant, and vitamin deficiency. Thereby, pathogenetic mechanisms of aseptic instability are studied, on the basis of the received facts recommendations about prevention of this complication are madeС целью изучения метаболических нарушений при асептической нестабильности эндопротеза тазобедренного сустава проведено биохимическое исследование сыворотки крови и суточной мочи у 31 пациента. Выявлены статистически значимые изменения местного и системного метаболизма, заключающиеся в росте остеолитических процессов, гипоксии, антиоксидантной и витаминной недостаточности. Таким образом, изучены патогенетические механизмы асептической нестабильности, на основе полученных данных даны рекомендации по профилактике данного осложнения

FEATURES OF SYNOVIAL ENVIRONMENT AND SUBHONDRAL AREA OF JOINTS IN PATIENS SUFFERING FROM GONARTROSIS

The aim of the work was to investigate the changes in the values of synovial fluid electrolyte composition in patients with degenerative-and-dystrophic involvements of the joints, as well as to study the dynamics of the mean optical density of femoral and tibial epiphyseal bone structures. The samples of synovial fluid have been studied, as well as the x-rays of 37 patients with deforming arthrosis of the knee of idiopathic and posttraumatic etiology. The decrease of ionized calcium value and the increase of total calcium/inorganic phosphate ratio value have been found. The change in the mean optical density of epiphysis shadow has been demonstrated to be depended on the stage of the pathological process. The relationship of the values of bone structure mean optical density and the concentration of synovial fluid electrolytes evidences the involvement of subchondral zone mineral component in the development of joint pathology. These values can be used as an additional criterion in osteoarthrosis diagnosis, as well as for assessment of subchondral bone condition by biochemical synovial fluid test

Some Aspects of Total Hip Replacement with Subtrochanteric Shortening Osteotomy in Patients with Congenital Hip Dislocation (Review)

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