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Total knee and hip arthroplasty (TKA and THA respectively) is frequently used in severe structural changes in patients with osteoarthritis (OA) and rheumatoid arthritis (RA).Objective: to evaluate the dynamics of the number of TKA of THA in patients with OA and RA treated in the Department of Traumatology and Orthopedics of V.A. Nasonova Research Institute of Rheumatology.Material and methods. The analysis of 11-year period (from 2012 to 2022) of surgical activity of the Department of Traumatology and Orthopedics of V.A. Nasonova Research Institute of Rheumatology.Results and discussion. Within the mentioned period, 2955 TKA and THA were performed in 1590 patients with OA and 1365 with RA. From 2012 to 2018, the number of surgeries in patients with OA and RA was approximately the same, but since 2019 there has been a significant increase in the number of total arthroplasties (TA) in OA. The median delta (Δ) of the number of TKA and THA performed annually over 11 years was 13.5 [-17.5; 75.7] in patients with OA and 2.5 [-10.25; 25.0] in patients with RA (p=0.032).Conclusion. In the last 11 years there was no significant dynamics in the number of TKA and THA in patients with RA. At the same time, there is a statistically significant increase in the number of TA in patients with OA, which is in line with the global trend.

Background. Hip arthroscopy is a minimally invasive surgical technique most commonly performed to correct femoroacetabular impingement (FAI). Currently, it is widely used by worldwide; in addition, there are a significant number of english-language publications on this topic. The number of hip arthroscopy performed in Russia is unknown. Information about this surgical technique is also very limited in our country. The aim of the study was to assess the level of hip arthroscopy in Russia. Methods. A total sociological survey of orthopaedic surgeon with experience in performing hip arthroscopy was conducted. The questionnaire was posted on the Google Forms platform and consisted of 13 questions of closed, semi-closed and open types. The survey included 54 surgeons from Russian clinics, 45 people filled out the questionnaire. Results. Among the respondents, doctors with experience in performing arthroscopic operations on the knee and shoulder joints predominated (100.000.00% and 93.300.03%, respectively). The majority of specialists (73.300.06%) were trained in hip arthroscopy during the primary course in one of the clinics in Russia. More than half of the respondents (68.800.06%) are currently engaged in this surgical area, however, in 45.160.07% of them, the number of operations does not exceed 5 per year. For surgeons who have completed two or more training courses, the volume of operations performed is higher (p0.05); 51.110.07% of doctors perform arthroscopy using an alternative technique. There are 2.5 time more specialists doing just bone resection, than surgeons who apply any kind of reconstruction technique while treating FAI (p0.05). Fifteen respondents (48.390.08%) perform debridement as an attempt to delay arthroplasty. The most common difficulties faced by surgeon are problems with the diagnosis of FAI (no patients) (40.000.02%), lack of the necessary tools (40.000.02%) and sufficient time to master the technique (33.300.07%). Only three (6.600.07%) respondents believe that they manage to achieve the planned results of the operation, 93.300.03% of surgeons said that it is not always possible to achieve the desired outcomes. Conclusion. Hip arthroscopy in Russia is not very common, the volume of such interventions is insignificant. Doctors with minimal skills in arthroscopic hip surgery predominate. Factors that impede the development of this area in our country are related to teaching methods, problems with FAI diagnostics, the lack of necessary instruments for performing operations, and the lack of time for specialists to master surgical techniques.

Introduction and purpose Total hip arthroplasty (THA) has revolutionized the treatment of various hip pathologies. This method of treatment leads to significant pain relief, improved function, and enhanced quality of life for patients worldwide. The following article provides an extensive overview of THA; covering indications, historical overview, surgical techniques, complications, as well as outcomes. Material and method The authors had analyzed both PubMed, as well as Google Scholar databases using the following key words: ‘THA’; ‘total hip replacement’; ‘total hip arthroplasty’; ‘hip’; ‘direct anterior approach’; ‘direct lateral approach’; ‘posterior approach’; ‘THA outcomes’. Conclusion THA is considered to be one of the most clinically successful and cost-effective medical procedures, which were developed during the last century. What is worth mentioning, the world’s highest-impact academic journal, The Lancet, called THA ‘the operation of the century’ in the year 2007. The historical perspective of total hip arthroplasty reveals the remarkable journey of medical pioneers who paved the way for modern techniques and materials. From the early days of simple hemiarthroplasty to the development of innovative prosthetic components and minimally invasive approaches, the field has undergone substantial progress, resulting in improved patient outcomes and longevity of the implants. Despite these advancements, the review highlights several challenges and complications associated with total hip arthroplasty. Through continued investment in research, and collaboration among orthopedic surgeons, engineers, and researchers, addressing these challenges can lead to further improvements and enhanced patient experiences.

Background.The effectiveness improvement and standardization of the methods of histological diagnosing periprosthetic infection (PPI) is an urgent task in the treatment of complications after large joint arthroplasty. Purpose of the study— Histopathological evaluation of the infection involvement of periprosthetic tissues at the stage of revision arthroplasty for deep infection of the hip using HOES scale and immunohistochemical analysis of CD15 expression. Materials and Methods.A single-center prospective study was performed on the clinical intraoperative material obtained at the stage of revision arthroplasty of the hip in 27 patients at the age of 65 (55÷69) years. The group of examination included patients with acute and chronic forms of deep periprosthetic infection. Light-optical microscopic investigation of the samples of periprosthetic connective-tissue membrane and bone tissue from the foci of infectious involvement was made on paraffin sections stained with hematoxylin and eosin; with the immunohistochemical reaction to determine the expression of CD15 neutrophil granulocyte markers. HOES Scale for pathohistological assessment was used in order to objectify osteomyelitis signs in periprosthetic bone tissue. Results. The signs of acute and chronic stages of periprosthetic osteomyelitis were observed in 9/16 patients with PPI chronic course within 1–30 months of postoperative period, from one to 18 months after manifestation of the symptoms. The signs of subsided osteomyelitis were determined in 12/27 patients with PPI of acute and chronic forms. Infected periprosthetic membranes were found in 19/27 clinical cases in the early and longterm time periods after arthroplasty surgery. A direct significant correlation was revealed between histopathological signs of infecting the periprosthetic bone and the connective-tissue periprosthetic membrane, especially strong one in patients with acute and chronic PPI osteomyelitis. Conclusion. The use of HOES Scale and the analysis of CD15 expression ensure the objectivity of PPI histological diagnosing. The results obtained indicate an increased risk of osteomyelitis development in patients with chronic periprosthetic infection after the hip arthroplasty.

Background One-stage revision arthroplasty has currently a limited use in treatment of a periprosthetic infection despite obvious economic benefits in comparison with two-stage revisions. This operation involves the removal of all implant components, radical surgical debridement, joint irrigation, installation of a new implant, and a long course of antibiotic therapy. Purpose To evaluate the effectiveness of one-stage revision arthroplasty in the treatment of patients with periprosthetic infection of the hip joint. Material and methods Results of treatment of 14 patients with periprosthetic hip infection who underwent the procedure of a single-stage revision arthroplasty in the period from 2009 to 2018 were analyzed. The average follow-up was 2.7 years (range, 1 to 10 years). Results Twelve (86 %) out of 14 patients with periprosthetic infection of the hip joint completed one-stage treatment successfully. Two (14 %) patients developed recurrent infection and had a two-stage revision arthroplasty using an antibacterial spacer. In accordance with the Harris Hip Score scale, the functional state of the limbs at a one-years follow-up after treatment averaged 77.7 points (range, 36 to 95). Conclusions One-stage revision is quite a laborious medical procedure, for which sufficient experience of orthopedic surgeons and a specialized hospital service. This method of treatment provided suppression of infection in 86 % of our cases. Negative factors in using one-stage revision were polymicrobial infection and implant dislocation in the early postoperative period.

Purposes of our study were to estimate clinical short-term results of custom acetabular implants using in revision hip arthroplasty, to determine bone ingrowth percentage in the custom implant 3d printed coverage, and to estimate the custom malposition influence on the clinical results.Materials and method. 30 patients were performed revision hip arthroplasty with using custom acetabular implants in 2016. Oxford hip score, life quality, expectation and satisfaction of patients were assessed in 12 months and more. Osteointegration was assessed with x-ray. Influence of malposition on clinical results was assessed with Pirson’s χ2.Results. Oxford Hip Scores were increased from mean 16.8 to 34.4 (p

This technique involves removal of implant components, debridement of the purulent focus and installation of a cement spacer which is subsequently replaced with a permanent implant after 3–9 months. Purpose To evaluate mid-term results of two-stage surgical treatment of patients with chronic periprosthetic infection of the knee and hip joints. Materials and methods Treatment outcomes of 172 patients with periprosthetic infection who underwent two-stage revision arthroplasty in the period from 2011 to 2015 were assessed. Among them, 113 patients developed infection after hip replacement and 59 patients had infected knee joint. The average follow-up period was 4 ± 1.58 years (range: 2 to 6 years). Results Out of 113 two-stage procedures of hip joint revision, 102 (90.2 %) cases showed an arrest of infection. Four (3.6 %) patients with recurrence of the purulent process underwent resection arthroplasty, another four (3.6 %) rejected to replace the spacer with an implant, and three (2.6 %) had a two-stage re-revision. Out of 60 (59 patients) procedures of a two-stage knee joint revision, infection was arrested in 50 (83.3 %) cases; eight (13.4 %) had recurrence and underwent knee arthrodesis. One (1.6 %) refused to replace a spacer for an implant, and one more (1.6 %) had a two-stage repeated revision. Conclusions Two-stage knee and hip revision arthroplasty using a cement spacer is an effective option for treatment of chronic periprosthetic infection. It provides infection control in 86.7 % (83.3 % for knee and 90.2 % for hip joints) of cases in the mid-term follow-up period up to 5 years. However, the rate of re-infection remains significant and reaches 13.3 % (9.8 % for hip and 16.7 % for knee joints).

Periprosthetic joint infection continues to be a challenging problem. The demand for total joint arthroplasty is increasing, and the burden of such infections is increasing even more rapidly, and they pose a great problem due to economic reasons and poor outcomes. This review describes the current knowledge regarding diagnosis of periprosthetic joint infection with testing erythrocyte sedimentation rate, serum C-reactive protein, Interleukin-6 and some other novel approaches.

Objective: to determine the dynamics of the extra-articular pain after primary hip replacement. Materials and methods. A total of 1286 patients undergoing primary total hip arthroplasty. Among the patients were women, mean age was 56.6 ± 13.9 years. In a clinical study of patients using differential diagnostic table extra-articular pain, visual analogue scale of pain, with instrumental examination – X-ray data, and sonographic densitometry study. Results. The incidence of the disease state is 42.7 %. Risk factors for decompensation classified muscles that stabilize the hip joint (r = 0.78), shortening of the operated limb more than 3 cm (r = 0.72). The most intense pain is fixed from the 3rd to the 6th month after the surgery. The least pronounced dynamics of reduction in pain severity observed in patients with dysplastic coxarthrosis and diseases arising on a background of systemic pathology. Conclusion. Extra-articular pain occurs more than a third of patients after primary prosthesis. According to the etiology is often vertebrogenic and adaptive pain. From the 3rd to the 6th month, in connection with the formation of a new dynamic stereotype of gait is highest probability of occurrence and/or enhance the intensity of the pain, which are reduced to 12th month after surgery.

Abstract:Surgical treatment of destructive and degenerative diseases of the hip arthroplasty technology with the modern development of science, technology and medicine is considered the most effective method of providing social and personal reintegration. However, the opinion of experts, arthroplasty increases the complication rate in patients after osteosynthesis and osteotomy of the proximal femur. The purpose of research - to compare patient outcomes Technology hip arthroplasty after-reducing reconstructive interventions at the proximal femur. Material and Methods: The study group comprised 42 patients who underwent hip arthroplasty after-reducing reconstructive interventions at the proximal femur. The control group consisted of 43 patients with idiopathic hip osteoarthritis who underwent primary arthroplasty. Results: conducting joint replacement in patients of the main group was accompanied by an increase in the frequency of intraoperative and postoperative complications. Therefore, this group of patients requires a special approach to diagnosis and treatment.

The article is devoted to some features of revision hip arthroplasty, especially to the prolapse of the acetabular component into the pelvis cavity. International literature review is presented, in which the authors warn surgeons about some possible complications during the removal of the components using retroperitoneal and external approach. In case of contact of acetabular component with neurovascular bundle in pelvis, foreign authors recommend retroperitoneal approach.

Objective: This study aimed to determine the capabilities of plastic and reconstructive microsurgery in treatment of patients with traumas and diseases of hip. Material and methods: We have studied the results of surgical treatment of 10 patients with pathology of hip. All the patients were treated in Vreden Russian Research Institute of Traumatology and Orthopedics (Saint-Petersburg, Russia) within the period from 2000 to 2011. All the patients had pedicled flap transfer (10 cases) or free tissue transfer (1 case). 6 patients had additionally primary or revision total hip replacement. Results and conclusions: Microsurgical operations mainly aimed to correct various pathological changes of soft tissues and to cure infectious process in hip area. It was stated that microsurgical operations themselves is an effective method of treatment of wide neurotrophic sores located in the area of hip joint as well as hematogenic osteomyelitis of hip joint. Only microsurgical technologies provide opportunities for successful total hip replacement in patients with combined pathology of para-articular soft tissues and bones.

Sonographic (SG) examination of hip joints was performed in 100 pts with juvenile chronic arthritis (JCA) with different forms, activity and duration. SG signs of hip joint inflammation in JCA were identified. SG features in pts with different disease duration, form and activity were revealed. SG changes of clinically unchanged hip joints were noted which may be of important significance for early diagnosis of coxitis. More wide use of arthrosonography in pediatric rheumatology was proved.

The article is exposition essence of problem of renewal of ability to work of a problem of restoration after amputation at the hip. The analysis of the standard program of the standard in traumatology programs of physical rehabilitation of patients after amputation and presents the results of the developed physical rehabilitation of patients with amputating the thigh stumps due to injury. The authors propose to use the means of physical rehabilitation in accordance with the flow dynamics of the reparative processes after amputation and clinical features of injury. All this contributes to the development of compensatory own human capabilities, resulting in remission. Since these funds most physiological, their correct application does not cause complications.

Objective: To analyze an effectiveness of anterior approach to the hip joint for sequestrectomy with myoplasty., Material and Methods: We have developed anterior surgical access for osteomyelitis of the femoral neck and head. Semi-oval incision is made in projection of the femoral head. Tendons of sartorius muscle and rectus femoris muscle are cut off from anterior spine of the iliac wing. Surgical field ensures sequestrectomy for osteomyelitis of the hip joint. Closure of osteomyelitis cavity is performed by the proximal parts of two anterior iliacus muscles. Surgical field may be enlarged by temporary intersection of iliopsoas muscle tendon., Results: The key to anterior surgical approach to the hip joint is sartorius muscle and rectus femoris muscle. The length of surgical wound reaches 17-22 cm, width - 16-18 cm. The mobilized proximal part of sartorius muscle is used for closure of the entire bone cavity in femoral neck and head. Stable long-term remission was observed in 11 (91.7±7.6%) out of 12 patients., Conclusion: Original surgical approach is less traumatic and ensured manipulations under an angle of about 90°. This access complements the advantages of the well-known anterior approaches and has no their disadvantages.

Objective - to study the effect of hip contractures on the strength of the thigh muscles. Gait analysis was performed in the OpenSim 4.0 program, gait2394 was taken as the basis. Created 4 models with contractures of varying severity. We analyzed the change in the work of the thigh muscles in normal conditions, with adduction, flexion-adduction and flexion-adduction contractures with shortening. According to the data obtained in modeling the adductive and flexor-adducing contractures of the hip joint, it can be noted that contracture changes the work of the muscles around the hip joint. It was noted that modeling only adduction contracture causes noticeable changes in the medial group of femoral muscles and muscle stabilizers. Of the muscles of the posterior thigh group, m.semimembranosus, m.semitendinosus and m.biceps femoris are most susceptible to changes. These muscles change the level of load, and most importantly, periods of excitation and muscle relaxation shift. Simulation of combined flexion-adduction contracture showed that muscle dysfunctions increase, and m.sartorius, an anterior thigh muscle, was added to the muscles in which noticeable changes additionally occurred. With simulated adduction and flexion adduction contractures, changes occur in all the muscles of the thigh, periods of their excitement and relaxation shift, but the level of muscle tension is close to normal values - not exceeding them by 20-30%. Flexion-leading contracture with shortening of the limb leads to a distortion of muscle parameters in the form of excessive loads for the step (up to 100-300%). Based on the obtained simulation results, the inability of the muscles to develop the necessary efforts leads to a change in the parameters of the step in the form of a decrease in the length of the step and the duration of the periods of support on the foot, a change in the nature of the transfer of the foot. It is logical to assume that a long period of impaired muscle function will lead to the development of sustainable changes in the walking pattern.

The dynamics of delayed onset of muscle soreness after exercise on an electrically driven cycle ergometer with floating seat under preferentially concentric and eccentric conditions (forward and backward rotation of the pedals) has been evaluated using three different tests. The delayed onset of muscle soreness was determined using three different procedures: two with active contraction of the tested muscle group in multi-joint (going downstairs) and single-joint (knee extension) movements and one with passive pressure applied to the central part of m. vastus lateralis. With the use of two active tests, the maximum delayed onset of muscle soreness was recorded on the 1st-3rd days after intensive bicycle exercise without significant differences between the groups. Under conditions of passive testing, a tendency to a slower development (both an increase and a decrease) of delayed onset of muscle soreness was recorded. A positive correlation between the relative tension and the delayed onset of muscle soreness was found. Relative tension was determined as a decrease of strength during recovery related to the initial level. No relationship between volume/duration of exercise and the delayed onset of muscle soreness was found.

The results of study of the elemental composition of bone tissue in patients with hip joint implants are described. The study was based on spectral analysis and correlation-regression analysis. It was shown that the elemental composition of bone tissue is not affected by long-term contact with the implant. This result should be taken into account in prophylaxis of implant instability.

MRI findings of 13 patients with soft tissue tumors (STT) are presented. There are were abnormalities, such as primary STTs of the hip in 5 patients, the back in 1, and the neck in 1, STT relapses of the hip in 2 and those of the back in 1. Two patients had chronic hip STT hematomas and 1 had hip STT metastatic melanoma. The diagnosis was verified in 11 cases (in 10 cases at surgery and 1 at needle biopsy). MRI makes it possible to define the accurate sizes of the tumor, its structure and relationship to its adjacent tissues, which is important in choosing at treatment policy, the type and scope of a surgical interventions.

Operations were performed on 242 patients (49 out of 110 children and 193 out of 220 adults) with nonorganic new growths of the true pelvis. Nine surgical approaches were used: transperitoneal (89 patients), transperitoneal-unguinal-femoral (2), extraperitoneal (48), transgluteal-transsacral (23), parasacral (14), transuterine (4), interlabial (2), perineal (16), combined (44). The transperitoneal approach was used most frequently--in 52.0% of patients (taking into account the combined approach), more often in children than in adults, and more often in males than in females. The choice of the approach was mostly guided by the location and size of the new growth in the true pelvis.

Topographic anatomical investigations have established the possibility to make a new complex skin flap on the lateral surface of the femur on the branches of the second perforating artery and vein. The authors propose methods of making a transplant in this field on two vascular pedicles with anastomoses in one of them--a larger one and two separate flaps: a skin-fat and a muscular flaps on a single feeding pedicle. The experimental findings were confirmed by successful clinical observations.

Cross-striated muscular tissue in white rats was studied histologically and morphometrically after the effect of laser. In the first series of the experiment (25 rats) the tongue, musculus masseter and femoral muscles were cut by means of carbon dioxide laser device "Scalpel-1" changing its power within the limits of 20, 40, 60, 80, 100% from maximum (35V). Immediately after the procedure, the pathological focus along the line of the incision had clear borders and consisted of a line of coagulated necrosis and a zone of necrobiosis. Its size was 48-75 mkm and depended on the power of irradiation and on how the laser ray was directed towards the course of muscular fibres. A definite difference was revealed in the size of zones of coagulated necrosis and necrobiosis of lingual myons situating lengthwise and across the axis of the laser ray. In the second series of the experiments (50 rats) regeneration of the tongue and musculus masseter was studied. On the first day, edema and infiltration were insignificant because of coagulation of the blood vessels. Capillaries with the diameter of 20 mkm were forming from the preserved vessels and growing into the granulation tissue. On the second week, young muscular elements appear in the regenerate. Nonresorbted areas of the coagulated tissue impede myonic regeneration. On the 35-40 th day, fine muscular fibres, connective tissue and capillaires of normal size can be found within the traumatic area. The data obtained are compared with the results on reactivity of skeletal muscles after other types of lesions.

Experiments set up on mice demonstrated that galanthamine, hydrobromide, physostymine salicilate and iodomethylate produce a fall of the renal temperature, the hypothermal effect being proportional to the suppression of the cerebral cholinesterase. Anticholinergics benactyzine and atropine were largely capable of preventing hypothermia produced by the introduction of galathamine hydrobromide, the latter increasing the resistance of the animals to the action of high temperature.

The author has analysed the results of the treatment of 214 patients aged 6 to 14 years with acute hematogenous osteomyelitis of the hip. The peculiarities of development of orthopaedic complications of acute hematogenous osteomyelitis of the hip have been regarded in the age aspect at various stages of the course of the inflammatory process. A classification of complications has been proposed. Among the causes of pathophysiological character contributing to the development of early orthopaedic complications, activity of of the contracted muscles and disturbances in haemodynamics in the focus of inflammation have been marked. As for the organizational causes, a positive role of early diagnosis and early sparing surgical intervention in the conditions of a department of orthopaedics and traumatology for children has been pointed out.

An autopsy observation of alveolar soft tissue sarcoma of the left hip muscles in a man of 66 is described. Predominantly lymphogenic metastasizing of the alveolar sarcoma was observed and two hypes of tumour cells, "dark" and "light" were distinguished. PAS-positive substances, lipids and mucus were found in the cytoplasm of the "light" cells. Histogenetically, the alveolar soft tissue sarcoma is assumed to be close to striated muscles.

Electron microscopic examinations of two malignant fibroxanthomas revealed some ultrastructural features characteristic of this tumor. The tumor elements were represented by histiocyte-like, fibroblast-like and little differentiated cells. In some of the latter the signs of macrophage differentiation could be seen and therefore a possibility of their transformation into histiocytes is assumed.