The  OBJECTIVE  is to determine the  possibilities of using  tranexamic acid  for hip arthroplasty in patients receiving  renal replacement  therapy. MATERIAL AND METHODS.  The  material   for  the  study   was   based on  the  data   of  31  patients with pathology of the  hip who  underwent primary  total  hip arthroplasty from 2015  to 2017  at  the  Clinic of Traumatology and   Orthopedics  of  the  «Pavlov   First  Saint   Petersburg State  Medical  University».   RESULTS.   The  study   proves the safety   of  using   tranexamic  acid   for  total  hip  arthroplasty  in  chronic   hemodialysis patients.  CONCLUSION.   The   use of tranexamic acid  for hip arthroplasty in patients receiving  renal  replacement therapy allows  to  reduce blood  loss.  The efficacy  was  33  %  (p<0.05).   It is  necessary to  strictly  adhere to  the  frequency of introduction  of tranexamic acid,  and dose  adjustment depending on  the  concentration of  blood  creatinine.

Vitamin D takes part into the metabolism of the bone tissue, regulating the processes of mineralization and remodeling. There are a lot of data on uses of using of vitamin D in patients of trauma and orthopedic profile, but opinions about the method of taking, dosage, effectiveness differ greatly and requires more in-depth research.The objectiveof this study was to review and analyze of actual clinical and experimental researches related to the influence of metabolites of vitamin D in the endoprosthesis of large joints, among the available sources of medical database of PubMed, Cohraine, e-Library.The results of most studies of local and systemic use of metabolites of vitamin D led to the conclusion about the beneficial effects of these compounds on bone regeneration in traumatology and orthopedics. However, further researches are required to clearly identify the clinical application of these approaches.We supposed that the following factors considered for long-term work: assessment of long-term effect and usage of standardized doses, learning new derivatives of vitamin D, synergy in the combinations of vitamin D preparations, pharmacokinetics of vitamin D preparations and polymorphisms of genes associated with vitamin D, genes influencing the life activity of bone and assessment of the effect of concomitant disease, systemic pathological processes on related of vitamin D metabolism, and bone restoration. We are also define the simultaneous corrections of vitamin D levels as an important component of the compensation of bone disorders in trauma and orthopedic patients.

Purpose — to evaluate mid-term outcomes of primary hip replacement in patients with end-stage chronic renal disease and to develop an algorithm for selection of surgical tactics and perioperative treatment.Materials and Methods. The authors evaluated outcomes of primary hip replacement in 45 patients receiving renal substitution therapy and 47 patients without chronic renal disease. Patients with end-stage chronic renal disease (CRD) were divided into two groups: group I included 30 (66.6%) patients receiving chronic hemodialysis (CH) and group II included 15 (33.4%) patients after renal transplantation (RT). Group III of 47 (51.1%) patients without any signs of CRD who underwent hip arthroplasty within relevant period of time was established to evaluate the effectiveness of primary hip replacement. Blood serum Ca2+ and P5+ levels as well as levels of parathyroid hormone (PTH) and 1.25-dihydroxyvitamin D were measured to determine the rate of calcium- phosphoric metabolism disturbance. Multi-spiral CT scans of hip joint were performed to identify bone mineral density and the mean Hounsfield (Hu) value was calculated for which the data was obtained from five various points on the proximal femur and acetabulum. Beta-2 microglobulin (B2M) blood test was performed to confirm amyloid bone disease.Results. The authors did not observe statistically significant differences for arthroplasty outcomes in patients of group II and III. Patients receiving long-term hemodialysis demonstrated significantly lower parameters of Harris score and Barthel’s index of social adaptation after hip replacement as compared to groups II and III: patients of group I demonstrated outcomes improvement at 19.55%, in group II — at 13.03%, in group III — at 10.15% as compared to preoperative status. Decrease of 1.25-dihydroxyvitamin D below 20,0 mcg results in resorption of cancellous bone in proximal femur and acetabulum along with myopathy of gluteus muscles. Sharp increase of parathyroid hormone level (over 600 pcg/ml) was accompanied by inhibition of osteoblasts proliferation and differentiation resulting in substantial impairment of mineralization.Conclusion. According to the algorithm suggested by the authors the key parameters that need to be evaluated in preoperative period are parathyroid hormone (PTH) and 1.25-dihydroxyvitamin D. Five-fold increase of PTH (>600 pcg/ml) demands parathyroidectomy as the first stage of treatment to decrease risk of early aseptic loosening of hip prosthesis and development of periprosthetic fracture.

The guidelines describe modern approaches to the prevention, diagnosis, and treatment of thromboembolic complications in patients with injuries and after musculoskeletal surgery, in accordance with the interdisciplinary draft of the Clinical Guidelines (2022) Deep vein thrombosis of the extremities, which has passed public hearings and is being approved by the Russian Ministry of Health. The guidelines are designed for doctors of various specialties to provide medical care to specialized patients: orthopedic surgeons, anesthesiologists, resuscitators, clinical pharmacologists, health care organizers, medical students, residents, graduate students.

The article describes the observation of successful total hip arthroplasty in the patient with atrophic bilateral nonunion of femoral neck with end stage renal disease.Authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.