Dislocation of the acetabular component is one of the most frequent complications of total hip arthroplasty. It is commonly attributed to implant malpositioning. However, not all dislocations can be explained by this hypothesis. The aim of our study was to elucidate the role of intraoperative injury to hip abductors (m. gluteus minimus in the first place, since it is reportedly an important hip stabilizer) in the development of postoperative hip dislocation. The experiment was conducted in 4 male and 3 female cadavers. A total of 12 THA were performed. The Hardinge and Watson-Jones approaches were used in equal proportion. On plain radiography, acetabular inclination was 40–47°, anteversion was 10–22°; technically and biomechanically, these values were within the normal range and did not depend on the type of surgical approach (for inclination, p = 0.94; for anteversion, p = 0.63), ruling out implant malpositioning as a risk factor for hip dislocation. Nevertheless, implant stability was significantly disrupted following transection of the anterior or posterior fascicle of m. gluteus minimus, leading to the dislocation of the acetabular component in standard rotation and flexion tests. Thus, our study shows the significant role of m. gluteus minimus in stabilizing the hip joint. Preservation or adequate repair of this muscle during surgery will reduce the risk or dislocation and help to restore the anatomy and biomechanics of the operated joint.
Severe complex deformities of the forefoot in elderly patients with no rheumatoid arthritis result in the pronounced decrease in quality of life, chronic pain, reduced mobility, failure to get shoes for everyday use, exacerbation of the concomitant somatic diseases. The use of conventional joint preservation techniques in such patients often leads to the deformity relapse, persistent pain, and the need for revision surgery that is often impossible due to worsening of the patients' general somatic status and local functional status. The study was aimed to improve surgical outcomes in elderly patients with no rheumatoid arthritis who had severe forefoot deformities. The prospective cohort study that involved allocation to the retrospective group for comparison of surgical outcomes in 65 patients was carried out in 2016–2019. The results obtained before and after surgery were assessed using the FFI, AOFAS Hallux, and AOFAS Lesser Toes scores. The Maryland scores were used to assess the outcomes during the postoperative period. The study revealed significant differences in treatment outcomes based on the AOFAS Hallux (p = 0.0001), AOFAS Lesser Toes (p = 0.0001), FFI (p = 0.0001), and Maryland (p = 0.0001) scores. In view of the elderly patients' specific nature, the radical surgical techniques that do not ensure joint preservation may be considered as effective and predictable methods of correction aimed at reducing the rate of revision surgeries. These techniques represent a one-step method to improve the quality of life of elderly patients.
Despite the diversity of surgical options for slipped capital femoral epiphysis (SCFE), there is an ongoing search for the technique that would ensure a satisfactory outcome, stable fixation of bone fragments and a low rate of complications. The aim of this study was to improve the surgical technique for SCFE in patients with moderate and severe SCFE. The study included 52 children (16 girls and 36 boys) aged 10-15 years (the mean age was 13.2 years) with chronic severe (Krechmar’s stage III) stable (according to Loder’s classification) SCFE. The control group (n = 16) underwent a classic Imhauser procedure; the main group (n = 36) underwent a triplane osteotomy proposed by the authors of the study. The patients were examined prior to surgery and in the late follow-up period (the mean follow-up time was 4.7 years, ranging from 1 to 10 years). The procedure included a clinical examination, history taking, radiography to measure the slip angle and the severity of the slip, and the Harris hip score to assess hip function. After 4.7 years, both groups demonstrated an increase in the range of motion, in comparison with their preoperative results (p ≤ 0.05), good Harris hip scores (94 points in the main group and 81 points in the control group. Postoperative radiographs showed consolidation of the bone, recovery of the proximal femur anatomy. Leg length discrepancy improved significantly in both groups. The proposed technique for extraarticular osteotomy allows recovering the length of the affected leg, the anatomy and physiology of the hip joint, is simple and less traumatic.
Vozniknoveniye vyvikhov bedrennogo komponenta endoproteza — odno iz chastykh oslozhneniy endoprotezirovaniya tazobedrennogo sustava. Naiboleye populyarnym ob"yasneniyem vozniknoveniya dannogo oslozhneniya yavlyayetsya mal'pozitsiya komponentov endoproteza. Odnako ne vse vyvikhi udayetsya ob"yasnit' iskhodya iz dannoy gipotezy. Tsel'yu raboty bylo utochnit' znacheniye v geneze dannogo oslozhneniya povrezhdeniya myshts abduktorov bedra i v pervuyu ochered' m. gluteus minimus, opisyvayemoy v ryade istochnikov kak vazhnyy stabilizator tazobedrennogo sustava. Dlya izucheniya dannogo tezisa byl postavlen eksperiment s ispol'zovaniyem chetyrekh muzhskikh i trekh zhenskikh biomanekenov. Bylo proizvedeno 12 ustanovok endoproteza tazobedrennogo sustava. V ravnykh dolyakh primenyali dostupy po Hardinge i Watson–Jones. Po dannym rentgenkontrolya, naklon vertluzhnogo komponenta sostavil 40–47°, anteversiya — 10–22°, chto tekhnicheski i biomekhanicheski sootvetstvuyet dopustimym znacheniyam, zavisimost' dannykh pokazateley ot tipa dostupa statisticheski ne znachima (dlya naklona vertluzhnogo komponenta p = 0,94; dlya anteversii vertluzhnogo komponenta p = 0,63), chto isklyuchalo mal'pozitsiyu komponentov kak faktor riska vyvikha. Tem ne meneye pri peresechenii perednego ili zadnego puchka m. gluteus minimus stabil'nost' endoproteza sushchestvenno narushalas', chto privodilo k vyvikhu bedrennogo komponenta pri vypolnenii standartnykh testov rotatsii i sgibaniya. Takim obrazom, pokazana znachimost' m. gluteus minimus v stabilizatsii tazobedrennogo sustava. Sokhraneniye ili tshchatel'noye vosstanovleniye yeye struktury v khode vypolneniya operatsii pozvolit ne tol'ko provesti profilaktiku vozniknoveniya vyvikha, no i vosstanovit' boleye pravil'nuyu anatomiyu i biomekhaniku operirovannogo sustava.
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