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The objective: to develop the procedure for etiological diagnosis of infectious coxitis (IC) depending on the patient's HIV status.Subjects and Methods. The data of medical records of 97 patients with signs of IC were analyzed. Patients were divided into group depending on their HIV status.Results. The time required to diagnose IC was identified, and it made 7.35 ± 1.30 months for HIV-positive patients, and 6.25 ± 0.90 months for HIV negative patients (p > 0.05). The procedure was developed to be implemented when a patient complained of pain in the hip joint. Patients with HIV infection and suspected IC should undergo computed tomography (CT) of the hip joints, and HIV-negative patients should have CT done if the hip joint X-ray is not informative. The use of CT in the HIV+ Group reduced the diagnostic time from 9.4 ± 1.3 to 5.3 ± 1.3 months (p = 0.680), in the HIV- Group – from 8.7 ± 1.2 to 3.8 ± 0.6 months (p = 0.02). The reason why diagnosis took that long was the rare use of invasive methods at the outpatient stage. Thus, puncture of the hip joint was performed in the HIV+ Group in 2.7% of cases, in the HIV- Group – in 10%. Trepanobiopsy performed in a hospital made it possible to establish the etiology of IC in all patients. The diagnostic efficacy of microbiological tests in case of tuberculous coxitis made 48.64% in the HIV+ Group and 30.0% in the HIV- Group, in case of nonspecific coxitis it was 32.43% and 30.0%, respectively.

The objective: to evaluate the possibility of using linezolid, amikacin, levofloxacin and bedaquiline mixed with bone cement for the treatment of patients with tuberculous arthritis taking into account changes in mechanical properties of bone cement, antimycobacterial activity of drugs and characteristics of their release.Subjects and Methods. The antimycobacterial, elution and strength characteristics of bone cement mixed with the drugs known for their anti-tuberculosis activity were studied: linezolid, amikacin, levofloxacin, and bedaquiline. The antimycobacterial effect was evaluated by the minimum inhibitory concentration (MIC) of the reference strain of Mycobacterium tuberculosis H37RV sensitive to anti-tuberculosis drugs (TB drugs). To study the kinetics of elution, the methods of high-performance mass spectrometry and spectrophotometry were used. The strength characteristics were determined using LFM-50 electromechanical testing machine.Results. The obtained results demonstrated satisfactory elution and antimycobacterial parameters for linezolid and amikacin, thus they can be mixed with bone cement, and the cement retained its strength characteristics. Levofloxacin showed antimycobacterial activity only within 1 day after the cement sample was immersed in the solution. Bedaquiline showed negative elution and antimycobacterial characteristics in the cement sample.

The objective: to analyze results of stabilizing techniques in the surgical treatment of tuberculous arthritis of appendicular joints, to define their place in treatment of tuberculous arthritis.Subjects and Methods. Data of 8 patients who underwent surgery for tuberculosis of appendicular joints were analyzed during the study. 7 patients suffered from tuberculosis of rare localization: ankle – 3 cases, foot – 1 case, wrist – 3 cases. And 1 patient suffers from tuberculosis of the knee joint, underwent arthrodesis, which eventually failed, had quadriceps fibrosis with no patella. At the time of the study, athroplasty couldn’t be performed in all 8 patients, so stabilizing surgery including arthrodesis was the method of choice. With the active tuberculosis disease and an extensive bone defect of the joint in 5 patients, static cement spacers loaded with anti-tuberculosis drugs were used. Spacers were used both for two-stage surgical treatment (2 cases) and one-stage (3 cases).Results: in all 8 cases, the stable eradication of tuberculosis infection was achieved with a follow-up period from 6 months to 7 years, average duration of follow-up made 2.2 Ѓ} 1.4 years. In 5 patients with tuberculosis of the ankle, foot and former knee joint, the support ability of the extremity was restored. With the stabilization of the wrist in a functionally advantageous position, all 3 patients showed a significant improvement in hand functions. After the spacer was installed, all patients were scheduled for the second stage of the operation but 3 of them achieved a good functional result, thus it was possible to avoid the next stage. The main criterion for stabilizing surgery of joints may be the impossibility of performing arthroplasty in cases of extensive bone defects as well as in case of persistent loss of anatomical structures.

The review analyzes publications devoted to experimental studies of antimicrobial agents with anti-tuberculosis activity added to bone cement.It presents information about the prospects of using antimicrobial agents in bone cement for treatment of infectious joint diseases.

The objective: to assess the elution characteristics of anti-tuberculosis drugs (isoniazid, cycloserine, rifampicin, amikacin, kanamycin, ethambutol) placed into bone cement samples and put in a liquid medium to determine the possibility of using such systems as a drug reservoir.Subjects and methods. For in vitro studies, pure substances of the drugs were used. The spectrophotometry was used to study the elution kinetics of the drugs. Absorption spectra of the drugs in the visible and ultraviolet regions were analyzed to reveal the absorption maxima, and the resistance of the chemical structure of the drugs to heating was assessed. Further, the changes of drug release from hardened bone cement samples under static conditions were studied.Results. It has been found that studied drugs demonstrated satisfactory parameters of thermal stability and elution which makes it possible to use them in a mixture with bone cement.

The objective: to study the specific diagnostics of inflammatory lesions of the osteoarticular system depending on the patient's HIV status.Subjects and methods. The medical records of 166 patients with signs of inflammatory changes in the osteoarticular system were analyzed. Patients were divided into groups depending on their HIV status. Results. Tuberculosis was the major cause of osteoarticular inflammation in HIV positive patients (58.21%), while it was much less frequent in HIV negative patients (13.13%) (OR = 9.214; 95% CI 4.314; 19.680). HIV positive patients were found to have lower leukocyte counts (6.18 ± 0.24 per 109 cells/l versus 9.40 ± 0.43 per 109 cells/l in the group of HIV negative patients, p

The objective: to analyze the results of surgical treatment of tuberculosis and non-specific arthritis of large joints of extremities by two-stage endoprosthesis replacement using cement articulating spacers saturated with antibiotics. Subjects and methods. The prospective single-center cohort trial included 36 clinical cases in 35 patients with purulent destructive arthritis of the hip, knee, and shoulder joints, who underwent two-stage surgery from 2010 to 2018. This method implied using cement articulating spacers at the first stage of surgery followed by replacement with a prosthetic implant. Joint tuberculosis was diagnosed in 7 (20.0%) patients, all other cases were non-specific arthritis. Results. In all 36 cases, patients underwent a full cycle of two-stage endoprosthesis replacement of joints affected by tuberculosis or non-specific infection resulting in pronounced destructive changes. In 33 clinical cases of the patients (91.67%), a positive outcome was observed with restoration of joint and extremity function in general with persistent eradication of the infection. An unfavorable outcome was obtained in 3 patients due to development of periprosthetic infection and loosening of the implant, 2 of them had tuberculous arthritis.

The article presents the results of the study, the purpose of this study is to evaluate the application of the combined low flow anesthesia with sevorane, epidural anesthesia and multi-mode post-surgery analgesia compared to multi-component intravenous anesthesia. 22 patients in the age from 25 to 46 years were included into the study. The physical state of the majority of patients corresponded to ASA II. Results of this study allow recommending the combination of the low-flow anesthesia with sevorane and epidural analgesia in the post-surgery period as a method of choice for surgical treatment anesthesia of tuberculosis spondylitis. This method provides stable intra-surgery state of the patient, it is highly reliable and allows expanding anesthesia area and use of epidural catheter for post-surgery pain relief.