The use of shoulder joint replacement has increased significantly since the early 2000s. The method, initially used as the gold standard for the treatment of osteoarthritis, has long gone beyond the generally accepted indications, expanding its use for the treatment of shoulder joint injuries and their consequences. The new generation of implants has led to improved outcomes such as functionality, range of motion in the shoulder joint and patient satisfaction. The decision to perform anatomical endoprosthetics (hemiarthroplasty, total shoulder joint replacement) depends on the degree of osteopenia, the viability of the humerus head, the integrity of the tubercles or the functional state of the rotator cuff of the shoulder. This type of arthroplasty remains for patients with a functional rotator cuff. Reversible endoprosthetics is today the preferred treatment option for non-fusion or improper fusion of the proximal humerus with a collapse of the humerus head or a non-functioning rotator cuff. Despite the limitations and complications reported in the literature, revision arthroplasty has a good potential for functional improvement in patients with the consequences of injuries of the proximal humerus. This is a group of patients, which is a difficult task for a surgeon. As further research is carried out, implant designs and their clinical application will continue to evolve.
Aim: improvement of outcomes of slipped caput femoral epiphysis.Materials and methods: This article analyses the treatment of 198 patients with different stages of slipped caput femoral epiphysis.Results: due to the high rate of disability in patients with slipped caput femoral epiphysis and the variety of methods of surgical treatment of this pathology, the analysis of the most common treatment options for slipped caput femoral epiphysis, depending on the stage of the disease, was carried out and the algorithm to determine the most appropriate surgical treatment option was developed.Conclusions: The developed algorithm for surgical treatment choice in juvenile slipped caput femoral epiphysis makes it possible to decide on the treatment of slipped caput femoral epiphysis as quickly as possible and to perform surgical treatment at an early stage, immediately after the pathology is identified.The treatment methods used in the development of the algorithm are for the most part technically simple to perform. The fixation methods make it possible to carry out early activation and rehabilitation of the patient, which considerably improves the patient's quality of life.
Aim: to describe the epidemiology, possible causes and predisposing factors for the development of slipped capital femoral epiphysis. To follow the evolution of classifications. Analyze indications for surgical treatment, as well as types of surgical treatment. Materials and methods: this review article analyzes the data of Russian and foreign literature on the etiology, pathogenesis, diagnosis and treatment of slipped capital femoral epiphysis. Results: in view of the frequent distribution in the population, high risks of disability in pediatric patients, the issue of treatment of slipped capital femoral epiphysis remains very relevant. Many methods of surgical treatment have been proposed depending on the stage of the disease, however, they have their own advantages and disadvantages. Conclusions: Conservative treatment in the long term did not show good results, generally accepted, according to most sources of literature, surgical treatment is considered. The gold standard in the surgical treatment of the disease does not exist today, and the methods and tactics of treatment are being improved.
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.
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