Prosthetic joint infection (PJI) after primary hip arthroplasty (PHA) in most cases results in severe surgical and socioeconomic problems. Along with improving the technical support of arthroplasty and antibiotic prevention schemes, a key point in reducing the rate of infectious complications is predicting of PJI in each individual patient. The purpose of the study was to reveal the key features of our patients with infectious complications after PHA in comparison with the patients with a successful outcome of arthroplasty. Materials and Methods. The outcomes of 249 cases of PHA were evaluated retrospectively. 115 of them subsequently developed PJI (main group) and 134 were without infectious complications (control group). The comparative analysis of the groups was aimed at identifying the key preoperative, intraoperative and postoperative factors for PJI, as well as combinations of the factors characteristic for our patients. Results. The risk group for the development of infectious complications included patients undergone hip surgery (p<0.001), body mass index >40 kg/m 2 (p = 0.170), preoperative hemoglobin <115 g/L (p = 0.063), duration of the operation >90 min (p<0.001), intraoperative blood loss >410 ml (p<0.001), CRP >69 mg/L on day 4 th to 5 th after PHA (p<0.001), as well as a combination of 4 or more of the above factors (p<0.001). Conclusion. We believe that the correction of the management tactics of such patients taking into account the identified risk factors will reduce the incidence of PJI after PHA.

Two-stage revision arthroplasty in chronic hip periprosthetic joint infection cases is the “gold standard” treatment. First stage debridement leads to large intraoperative and drainage blood loss using standard protocols for thromboprophylaxis and drainage of the surgical wound, which is a significant disadvantage of perioperative management of such patients.The aim of the study was to determine the effect of modified management protocol with delayed start of thromboprophylaxis and a short period of drainage on the blood loss and the effectiveness of debridement with antibiotic-impregnated spacer placement in patients with hip periprosthetic joint infection.Materials and Methods. A single-center prospective study was conducted. 90 patients underwent endoprosthesis components removal and antibiotic-impregnated spacer placement. Patients were divided into 3 groups: start of thromboprophylaxis before surgery and 3–4 days of drainage; start of thromboprophylaxis no earlier than 12 hours after surgery and 3–4 days of drainage; start of thromboprophylaxis no earlier than 12 hours after surgery and 1 day of drainage.Results. There was a statistically significant (p<0.05) decrease of drainage and total blood loss, and transfused blood volume in cases with the delayed start of thromboprophylaxis and a short period of drainage. The proposed protocol was safe for prevention of venous thromboembolic complications and did not affect the frequency of periprosthetic hip joint infection recurrence. The effectiveness of the first stage of treatment — 89%, the second stage — 99% in 1 year after rehabilitation according to the second international consensus on musculoskeletal infection criteria.Conclusion. The modified protocol of perioperative management is an effective and safe as a blood-saving strategy and can be proposed for widespread use.

Доля ревизионного эндопротезирования (реЭП) по поводу перипротезной инфекции (ППИ) тазобедренного сустава (ТБС) в специализированном ортопедическом центре составляет 44,76%. В результате тотального удаления имплантатов формируются значительные дефекты кости. Целью нашего исследования было оценить эффективность субтотального (частичного) реЭП у больных хронической ППИ ТБС. Были сформированы две группы больных: одноэтапное частичное реЭП (IэтЧЭП, n=11 (47,8%)) и частичное двухэтапное реЭП (IIэтЧЭП, n=12 (52,2%)). Когорта исследования составляла 3,2% от общего числа больных хронической ППИ ТБС в изученный период. ППИ купирована у 90,9% больных группs IэтЧЭП и у 83,3% IIэтЧЭП. В группе IIэтЧЭП значимыми факторами риска рецидива ППИ были решение о выполнении пациентам двухэтапного реЭП (OR 3,