Relevance. Total hip joint arthroplasty with a wide range of both classical and modifi ed approaches is a successful method of treating joint diseases in the fi nal stages. It should be noted that in recent years, there has been an increased interest among scientists — specialists in this fi eld — in developing and implementing new, more optimal approaches for primary and revision arthroplasty.Research objective: to determine the advantages and disadvantages of surgical approaches in arthroplasty of the hip joint in patients with dysplastic coxarthrosis.Material and methods. For this study, we observed 80 patients (18 men, 16 women) aged 45 to 60 years with dysplastic coxarthrosis of the hip joint who were undergoing treatment in the trauma and orthopedics department of the therapeutic surgical clinic of the Azerbaijan Medical University. The comparison group included 25 patients who underwent total hip joint arthroplasty from a posterior-lateral approach; 25 control group patients underwent surgery with a Harding approach, and 30 main group patients underwent surgery from the proposed modifi ed approach. All approaches were performed as indicated. Before and 6 and 12 months after arthroplasty, the WOMAC index, C-reactive protein level, and ESR in the blood were studied in patients.Results. In the control group, some positive dynamics of clinical and biochemical indicators were noted at 6 and 12 months, but their values did not diff er signifi cantly from those of the comparison group (p > 0.05), but were signifi cantly higher than those of the main group (p < 0.001). Analysis of arthroplasty outcomes revealed a higher percentage of positive clinical outcomes with a signifi cant reduction in WOMAC index values and a decrease in C-reactive protein and ESR levels when using minimally invasive surgical techniques. Thus, the anterior approach with low intraoperative trauma is more optimal for patients with dysplastic coxarthrosis, as it promotes faster functional recovery and causes fewer infl ammatory complications. The posterior-lateral approach, like the anterior one, is optimal, since the above indicators did not diff er signifi cantly from those of the anterior approach. With the lateral approach, due to a higher risk of wound infection, the recovery time and reduction of the infl ammatory reaction are longer.

The aim of the study was to improve the surgical treatment outcomes for hip fracture by optimizing the methods of preoperative preparation for endoprosthesis, choosing the method of endoprosthesis and postoperative management of elderly and senile patients. The study was based on the analysis of the treatment outcomes of 339 patients with femoral neck fractures, aged 50-85 years for 2000-2019. 206 patients underwent endoprosthetic surgery without cement fixation; in 133 cases bone cement was used. 151 (44.8%) patients had total hip replacement with Deriuh and Zimmer implants performed within 1 to 2 days. 66 (19.5%) patients underwent surgery within 5 days, and the remaining 120 (35.5%) patients underwent endoprosthetic surgery within 8-10 days. When diagnosis has been made, the patient should undergo endoprosthetic surgery as early as possible. Preoperative preparation of this group of patients, in addition to standard procedure, also included the dopplerography, densitometry, and biochemical blood tests to determine the level of calcium. Summing up these diagnostic parameters, the severity of osteoporosis was determined that in turn allowed clinicians to choose the optimal tactics for hip replacement. The average duration of the operation was about 1 hour. In the postoperative period, patients were monitored in the intensive care unit for a day. A day after the operation, the patient can move relatively freely in bed. He can be allowed to sit down if he can. It is necessary to perform deep breathing exercises. Movements in the knee joint can be started from the first day. Next day, depending on the general condition, the patient can be allowed to sit on a chair near the bed or even walk with crutches. Before getting patients on their feet on the 2-3 day after the operation, dopplerography is performed. Walking with crutches lasts 2-3 days, but patients should not avoid the load on the operated limb; after this period the patient should walk with a stick, and in a few days without a stick. Walking with additional support is recommended for up to 10 days. The average period of inpatient treatment of this group of patients was up to 12 days. 151 patients, who had endoprosthetic surgery performed on within 5 days, had no hypostatic complications, thrombosis and thromboembolism; 3 patients were found to have cardiovascular insufficiency and one patient had bedsores. In 188 patients who had hip replacement performed on in 5 days and over since the fracture, the percentage of complications was as follows: hypostatic complications thrombosis and thromboembolism was found in 3 cases, heart failure – in 4 cases, bedsores – in 7 cases. Hip replacement in femoral neck fractures in the elderly and senile age should requires as early intervention as it possible thus, providing the main prevention of hypostatic complications and early rehabilitation of patients.