Цель исследования-определить темпы износа полиэтиленового вкладыша в зависимости от разных факторов и оценить связь скорости износа со степенью двигательной активности. Материал и методы. В исследование было включено 467 больных коксартрозом. женщин было 322 (35,8%), мужчин-145 (31,0%). средний возраст пациентов составил 55,0 лет, без статистически значимых различий у мужчин и женщин (р = 0,743). у 167 (35,8%) пациентов с помощью шагомера оценивалась ежедневная двигательная активность. у них оценивалась степень смещения головки эндопротеза относительно центра вертлужной впадины, и соответственно расчет степени линейного износа полиэтиленового вкладыша в программе Medicad. у всех пациентов оценивались показатели, полученные с использованием модифицированной шкалы активности Харриса и VaS. Все данные анализировались и подвергались статистической обработке. Результаты. средняя степень двигательной активности составила более 1,9 млн шагов в год. общая величина износа полиэтиленового вкладыша зависела от срока наблюдения, коэффициент корреляции пирсона составил r = 0,297 (р<0,001). средняя скорость износа составила 0,16 мм/год (95% ДИ от 0,15 до 0,17), при этом темпы износа статистически значимо различалась в группах стандартного и поперечносвязанного полиэтилена и составила 0,18 мм/год (95% ДИ от 0,17 до 0,19) и 0,11 мм/год (95% ДИ от 0,1 до 0,11) (р<0,001). В данной группе наблюдений дополнительными факторами, влияющими на темпы износа узла трения, являлись угол наклона вертлужного компонента, r = 0,241 (р = 0,002) и уровень двигательной активности, r = 0,574 (р<0,001). не выявлено очевидной связи темпов износа с возрастом, r = 0,14 (p = 0,859) и с индексом массы тела, r =-0,094 (р = 0,226), что, вероятно, объясняется сильным воздействием смешивающих факторов. удовлетворенность пациентов результатами операции, измеряемая по VaS, составила в среднем 91,1 баллов (95% ДИ от 90,3 до 91,9). показатели по Harris Hip Score улучшились в среднем с 36,5 (95% ДИ от 35,1 до 37,9) до 91,6 баллов (95% ДИ от 91,1 до 92,0) Заключение. Из многочисленных факторов, которые ассоциированы с уровнем износа узла трения, только наклон вертлужного компонента и более высокий уровень двигательной оказались статистически значимыми. Ключевые слова: эндопротезирование тазобедренного сустава, пары трения, износ полиэтилена, двигательная активность пациента, молодые пациенты.

теоретические и экспериментальные исследования т р а в м а т о л о г и я и о р т о п е д и я р о с с и и 2013-4 (70)

Purpose of the study - to evaluate in different groups of patients variability of anatomical changes that may affect the difference in the length of the lower extremities and affect on the results of the preoperative planning. Material and methods. As study material we used long film X-ays of 142 patients. A main group comprised 69 patients with varying severity of hip dysplasia. Control group consisted of 73 patients without hip pathology. All patients were performed long film X-rays, and measurements of relative and absolute lengths of the lower limbs, followed by analysis of the data. Results. Analysis of the measurements showed that none of the patients had absolutely equal length of the lower limbs, even in the control group in 56.2% of the observations noted the absolute difference of the lower extremities length more than 5 mm, and in 9.6% of patients - from 20 to 35 mm. In assessing the difference of the lower extremities length on AP pelvic view in the main group only one patient of 69 had the same length of the legs, and in 61 cases the difference was more than 5 mm, that it was clinically significant. Of practical interest is the fact that in the main group shortening of the operated limb was observed in 51 of 69 patients in AP views of the pelvis, but the results of measurements of the anatomical length of limbs long film X-rays compared with measurements of the relative shortening on the pelvis AP views showed that clinically significant difference exceeding 5 mm between measurements observed in 68.1% of cases. The greatest difference between the measurements of the limbs length on the pelvis AP views and long film X-rays observed in patients with unilateral hip dislocation and averaged 17.0 mm. Conclusion. Performing preoperative planning in patients with dysplasia only on pelvis AP views not allow properly compensate the difference of the lower extremities lengths, which may adversely affect the functional results of surgery and as a result, the patient’s satisfaction. Therefore, planning THA, especially at high hip dislocation, it is necessary to calculate the difference of the lower extremities lengths considering as the difference of the lengths on AP pelvis views and long film X-rays.

The literature review is dedicated to the problem of femoral component dislocation after primary and revision total hip arthroplasty. Modern data on surgeon-dependent and -independent risk factors for this complication development are analyzed. Potentialities for dislocation prevention using constrained liners and dual mobility system are considered.

Objective of the study: to identify differences in the functional outcomes of total elbow arthroplasty in posttraumatic and rheumatoid cases, to determine the factors affecting the outcomes and rate of the complication.Materials and methods. A retrospective study included 269 patients (272 elbows), who underwent primary total elbow arthroplasty (TEA), 100 men (37.2%), and 169 women (62.8%). The first group included 191 patients (191 elbows) who had elbow trauma. The average follow-up after the operation was 6.9 years (from 0.5 up to 21 years). The compared group included 78 patients (81 elbows) operated on for rheumatoid arthritis (RA). The average follow-up time after total elbow arthroplasty was 3.8 years (0.4 to 16.5 years).Results. Tea significantly improved joint function (mean values in post-trauma patients on the Mayo score were 73.8±14.1 points, on the oxford questionnaire — 30.5±8.9, DASH — 40.3±18.4, EQ-5D — 0.536±0.234; in patients with rheumatoid arthritis, on the Mayo score — 75.4±15.5 points, DASH — 38.6±15.8, OES — 35.5±7.9, EQ-5D — 0.580±0.2). In the first group, the frequency of postoperative complications requiring a revision was significantly higher than in the compared group (23.8% and 13.6%, respectively, OR 3.2; 95% CI 0.7-3.0). In the first group, a statistically significant risk of aseptic loosening of the implants was observed in patients operated on for pseudarthrosis of the distal humerus (OR 8.5; 95% CI 1.7-43.6) and post-traumatic deformity (OR 10.5; 95% CI 1.3-88.5). The use of some endoprostheses is also associated with a high risk of aseptic instability (OR 3.5; 95% CI 0.9-13.3). A significant risk of a deep periprosthetic infection was observed in patients with post-traumatic bone defect (OR 7.0; 95% CI 1.2-40.1) and post-traumatic deformity of the elbow joint (OR 14.0; 95% CI 2.5-77.8). Risk factors for loosening endoprostheses in patients with RA were: defective cementation of humeral component (OR 35.0; 95% CI 3.8325.0), valgus deviation of the humeral component 9° (OR 9.2; 95% CI 1.0-82.2), low constructive reliability of the endoprosthesis (OR 13.6; 95% CI 2.3-79.4), patient age 59 years (OR 12.8; 95% CI 1.5-113.0 ), BMI 32 kg/m2 (OR 8.4; 95% CI 1.5-47.5), and CRP level 36.1 mg/l (OR 4.8; 95% CI 0.4-65.8).Conclusion. Mid-term and longterm results showed that TEA helps restore the amplitudes of elbow movement and the function of the limb, both in elbows with post-traumatic consequences and with RA. However, the frequency of postoperative complications requiring a revision is significantly higher in the group of patients with consequences of the fractures than in the group of patients with RA.