Introduction. The literature review deals with the current state of the problem of the hip replacement (HR), in patients with rheumatoid arthritis (RA) are considered in order to systematize the accumulated experience. Materials and methods. A search was conducted for relevant scientific publications over the past ten years in the databases of evidence-based medicine Cochrane Lirary, PubMed and the electronic scientific library e-library. According to the selected keywords, 100 publications were selected and analyzed. Results and discussion. RA is a systemic autoimmune disease characterized by synovial inflammation, symmetrical erosive-destructive polyarthritis, progressive destruction of the joints with the development of severe deformities, as well as a wide range of extra-articular somatic and hematological manifestations. It was revealed that HR allows you to restore musculoskeletal function and significantly reduce pain, but in patients with RA it has a large percentage of local and general complications. As a result of severe connective tissue lesions, long-term hormonal and immunosuppressive therapy, the structure of bone tissue and the anatomy of articulated bones change significantly. The protrusio acetabula with significant medialization of the center of rotation of the hip joint require a special reconstructive hip replacement. The minimizing surgical trauma, the osteoplasty protrusion defect of acetabula, stability fixation of the prosthesis, specialized preoperative preparation, reducing the activity of the inflammatory process, the prevention of periprosthetic infection and the prevention of venous thromboembolism, the correction of anemia are becoming increasingly relevant. Conclusion. It has been established that the normalization of the joint rotation center, the restoration of the offset with bone grafting of the protrusion defect, reliable primary fixation of the cementless acetabular component of the prosthesis, provide biomechanical conditions for long-term and painless functioning of the implant. Perioperative management of such patients should include a multidisciplinary approach.
(THR). Inflammation in RA is the main factor manifesting anaemia, neutropenia, thrombocytosis and eosinophilia. The changes in blood components are important for the outcomes of major orthopaedic surgery. The purpose was to identify hematological parameters in RA patients undergoing THR and assess the effect on intraoperative blood loss. Material and methods Outcomes of 44 THR patients treated for grade III degenerative coxarthrosis (n = 21, OA group) and RA coxarthrosis (n = 23, RA group) in Ekaterinburg regional hospital № 1 between 2018 and 2019 were reviewed. The patients' age ranged from 41 to 70 years. Clinical, radiological, laboratory examinations, computed tomography and statistical analysis were used for the study. Cell counting was produced with the Sysmex XT-4000i automated hematology system. Statistical analysis was performed using the tools of Statistica software. Nonparametric Mann-Whitney test was used to compare cell counts between the groups. The Spearman Rank correlation was used to analyse the correlation between the the cell counts in the groups. For calculations, a significance level of р < 0.05 was adopted. Results There were no significant differences in the preoperative white blood cell (WBC), neutrophil, lymphocyte, monocyte, eosinophil counts between RA and OA groups. The RA group showed an evident decrease in red blood cell (RBC) count and haemoglobin level as compared to OA group. The RA group demonstrated the higher platelet count with mean platelet volume (MPV) being significantly lower than that in the OA group. WBC count, neutrophils, in particular, was shown to increase with lymphocyte, RBC, platelet count and hemoglobin, plateletcrit levels decreased at 24 hours postoperatively. There were no significant differences in WBC and RBC counts in the groups postoperatively. The differences in the MPV were leveled up in the groups with the platelet count being higher in the RA group as compared to the OA group. Conclusions Hematological parameters of RA patients who had undergone specific preoperative preparation were not shown to be associated with greater blood loss during hip replacement surgery. The leukocyte count leveled up in the preoperative and early postoperative periods can be indicative of the absence of a significant effect of RA on the postoperative inflammation.
A complex of rehabilitation measures for 72 patients with rheumatoid arthritis after total hip arthroplasty is presented. Complex restorative treatment was carried out: physical treatment aimed at restoring muscle function; physical and manual treatment aimed at reducing pain syndrome, teaching the correct load on the operated limb when walking with crutches and the recommended amplitude of movements in the joint. Stabilometry was performed on the BioMera platform, a complex for diagnostics, treatment, and rehabilitation of patients with motor pathologies «Trust-M». Methods of descriptive statistics were used. The main attention was paid to restoration or retraining of patients after hip arthroplasty to a normal dynamic walking stereotype. Patients were trained both to walk with and without crutches, to perform a normal walking cycle with the maximum possible observance of its normalized periods when transitioning to walking without support. For this purpose, the patient and others were familiarized with the rules of the normal walking pattern.
Introduction. The most effective method of treatment of patients with severe forms of coxarthrosis is endoprosthetics, the success of which directly depends on the correctness of preoperative planning based on knowledge of the morphology of the acetabulum in normal and pathological conditions. The aim of the investigation was to reveal the morphological features of the acetabulum in osteoarthritis of the hip joint, determining the technology of implant bed preparation for the prosthesis cup. Materials and methods. The study was conducted on 19 macerated pelvic preparations and 72 direct projection pelvic radiographs in 72 patients with stage III osteoarthritis of different etiology aged from 41 to 70 years (61.5 ± 1.4). Hyperplastic coxarthrosis was observed in 21 (29.2%), protrusion in 23 (31.9%), and dysplastic in 28 (38.9%) cases. Clinical, radiological, morphometric, and statistical methods of investigation were used. Methods of descriptive statistics were used. Results. The following data were obtained during morphometric studies: In hyperplastic coxarthrosis, the bottom thickness was 11.9±1.83 mm with an acetabular index (IVI) of 0.51±0.019; in protrusion coxarthrosis, the bottom thickness was significantly reduced and was 5.7 ± 0.93 mm, IVI of 0.66 ± 0.039; in dysplastic coxarthrosis, the bottom thickness was 14.5 ± 1.18 mm, IVI 0.42 ± 0.024 respectively. Discussion. Studies on acetabulum morphometry are being conducted worldwide; among residents of different countries, data on the depth of the acetabulum differ, the morphometric data obtained by us are relevant in terms of the variational anatomy of the population of the Ural region. The morphological features of acetabulum affect the technology of preparing the implant bed for the prosthesis cup, so the preoperative design of implantation is relevant. The proposed method of finding the center of rotation of the deformed acetabulum makes it possible to determine the required thickness of augments to compensate for bone defects in the area of the acetabulum floor and arch. Conclusions. The morphological features of the acetabulum in hyperplastic, dysplastic, and protrusion coxarthrosis determine the technology of implant bed preparation for a prosthetic cup.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.