The objective of the research is to study the causes and outcomes of infectious complications after total hip arthroplasty. The background of the research is the analysis of outcomes of 364 patients with complications after total hip arthroplasty; 369 cases, from 2005 to 2018. The infectious complications accounted for 21.7% (80 cases). The work involves clinical, radiological, microbiological, and statistical research methods. As a result of research causes of suppurative complications after total hip arthroplasty were: chronic infectious diseases of internal organs (t=3.37, p=0.001), instability of prosthetic components (t=3.14, p=0.002), over two previous surgical interventions involving the affected joint (t=2.43, p=0.005). In the treatment of periprosthetic infections, sanitizing interventions without the prosthetic components’ removal appeared efficient within only up to 3 weeks. If the sanitizing interventions were inconclusive, the double-stage revision prosthetics appeared adequate in a reliable number of cases (t = 11.2, p = 0.0028), namely 24, which amounted to 92.3%. In conclusion, it was concluded that the causes of periprosthetic infections were: diseases of the internal organs, instability of the components, over two surgical operations involving the same joint. The development of various complications after total hip replacements demands surgical revision procedures.

Summary. In the structure of complications, pain syndrome, which is not associated with infection or instability of the components of the endoprosthesis, remains a serious problem due to the difficulties of diagnosis and treatment. The cause of the residual pain may be the presence of spondyloarthrosis of the lumbar spine in the patient. Objective: to determine the role of spondyloarthrosis of the lumbar spine in the structure of pain after hip arthroplasty. Materials and Methods. A sample and retrospective analysis of the case histories of 138 patients with hip-lumbar syndrome who underwent hip arthroplasty in the Department of Traumatology and Orthopedics of Adults of the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine” was carried out. All patients were examined clinically and radiographically. Additionally, all patients were examined by a neurologist with the determination of the neurological status and diagnosis. Evaluation of the effectiveness of hip arthroplasty in order to improve the clinical and functional characteristics of the link hip joint – spine was carried out according to the Haris and Oswestry functional scales. Results. The analysis of the database of patients in them proved that the lumbar vertebrae at the L2-L4 level are more often affected. In hyperlordosis, degenerative lesions occur in the posterior column of the lumbar spine in the form of spondyloarthrosis, which is clinically manifested by lumbodynia; with hypolordosis, the anterior column suffers more, which is clinically manifested by the presence of lumboishalgia. Total arthroplasty of patients with hip-lumbar syndrome contributes to statistically significant (p≤0.05) reduction in pain syndrome and improvement of function both in the hip joint and the lower back. Residual, less intense, pain syndrome after arthroplasty was most intensive in patients with hypolordosis (24.11 points according to Oswestry’s classification). Сonclusions. The studies carried out to determine the role of spondyloarthrosis of the lumbar spine in the structure of pain after hip arthroplasty will contribute to the further development of a clinical diagnostic and therapeutic algorithm for patients with hip-lumbar syndrome.

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The aim. To study the results of revision endoprosthetics in patients with aseptic instability of the components of the hip joint endoprosthesis. Materials and methods. The basis of this work was the analysis of the revision prosthetics results in 152 patients (158 cases) with aseptic instability of components of hip joint endoprosthesis, who underwent surgery at the State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine” between 2008 and 2018. Total instability in the endoprosthesis components was observed in 43 cases (27.2 %), acetabular component instability – in 65 cases (41.1 %), femoral component instability was detected in 50 cases (31.6 %). Endoprosthesis dislocation occurred mostly between 5 and 9 years after the primary surgery. Clinical, radiological and statistical methods were used in the work. Results. Patients with acetabular component instability showed the best results of revision replacement for Paprosky I, II types acetabular defects (t = 9.3, P < 0.05). The vast majority of components became unstabile between 5 and 9 years after the primary replacement. The results of unstable femoral component revisions did not reveal any significant difference between cemented and cementless types of component fixation 10 years after the procedure. Recurrent aseptic instability was observed only in 7 cases, 5 of which (71.4 %) were fixated with cement. In the case of total instability, there was no difference in the revision implantation results between the use of primary components alone and in the combination with revision reconstructive systems. Component stability constituted the great majority (35 cases, which was 81.4 %) of cases after 10 years (t = 7.3, P < 0.05). The recurrent instability of one component was observed in 8 cases, which represented 18.6 % of the total number of revisions. Conclusions. In patients with instability of acetabular and femoral components in the presence of Paprosky I–II bone defects, the results of the revision replacement were better when implanting primary components using cementless type of fixation. The use of revision antiprotrusion acetabular and elongate femoral modular or monoblock systems with cementless type of fixation achieved better results in Paprosky III type acetabular and femoral bone defects. The revision of cemented components showed significantly worse results and implant survival rate compared to cementless fixation technique.