One of hip arthroplasty complications is dislocation of the endoprosthesis head. In the vast majority of cases, the cause of dislocation is multifactorial. That is why only a thorough analysis of the patient’s peculiarities, surgery and rehabilitation will help to avoid the relapse. This review analyzed the risk factors of dislocation and treatment tactics. Risk factors associated with the patient include: old age, male gender, obesity, concomitant diseases, low level of preoperative physical activity, low compliance and a some others. The problem of the biomechanical ratio in the segment “spine – pelvis – lower limb” deserves special attention. Besides, there are risk factors associated with the surgeon: access option; type, fixation and position of endoprosthesis components, experience and surgical technique of a orthopedic surgeon. The strategy of dislocations rate reduction is based on a detailed study of dislocation causes and their elimination, and adequate surgery planning. The treatment of a patient with dislocation should take into account the multifactorial etiology of the condition.
Treatment results for 65 patients were analyzed depending on the approach to the knee joint drainage after arthroplasty. Active drainage was performed using two large-diameter tubes (group 1, n=16), one large-diameter tube (group 2, n=20), one small-diameter tube (group 3, n=15). In group 4 (n=14), no drainage was performed. Hemoglobin level, knee joint circumference at the level upper patellar pole, volume of drainage discharge and the number of days for exudation via contraperture after drainage tube removal (groups 1-3), pain intensity by visual analog scale, terms of wound gluing and sutures removal, frequency of hemotransfusion were assessed. Statistically significant expediency of active drainage with 1 large-diameter tube and pleats was proved. Without drainage a statistically significant lower decline in hemoglobin levels on 3rd and 5th postoperative days was observed but the terms for wound edges adhesion and the period of knee edema increased.
Артропластика является единственным действующим методом борьбы с болью и скованностью движений у пациентов, страдающих остеоартрозом коленного сустава (КС). Описаны особенности эндопротезирования КС у пациентов с ревматоидным артритом.
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