Results of joint replacement in femoral neck fractures have been analyzed. During the period from 1994 to 2003 total hip replacement was performed to 399 patients with subcapital fractures including 372 patients in whom the operation was performed as a primary intervention. From 2002 to 2004 the total number of 290 hemiarthroplasty operations with use of module native implant was performed in 286 patients aged 76-101 years. In total joint replacement group intrahospital lethality made up 2% due to the following causes: pulmonary thrombembolia - 3 cases, acute cardiac insufficiency - 1 case, deep decubitus ulcers resulting in sepsis - 2 cases, polyorganic insufficiency on the background of severe concomitant pathology - 1 case. In the early postoperative period the following complications were noted: implant dislocation (5.2% of cases), intraoperative femoral fracture (3.5%). Infectious complications developed in 2 patients and in both cases removal of the implant was required. With mean-term follow-up native implants showed mean-term survival of 92-94% in 272 patients. Mean evaluation by Harris was the following: biometric «Sinko» and «ESI» implants - 83.1 points, PF «Sinko» implants - 89.3 points, combination of «Mathys» friction pair with native femoral component - 91.2 points. «Mathys» implants showed 94.6 points. Results of ЯРТЕЗ joint replacement were evaluated during the period from 1 to 3 years in 183 patients. Intrahospital lethality made up 1.8%. Excellent and good results were achieved in 53.7% of patients. Revision was required in 1.5% of cases. As concluded total hip replacement in femoral neck fracture was the effective treatment technique. It was reasonable both cement and cementless fixation with various implants for the optimum choice of implant in every specific patient. Use of modern module implants enabled to expand the indications for application of arthroplasty in elderly patients.
23 т р а в м а т о л о г и я и о р т о п е д и я р о с с и и 2013-2 (68) Введение Несмотря на успехи тотального эндопротезирования тазобедренного сустава, количество осложнений, сопровождающих эту операцию, остается достаточно высоким-5-7% [1, 2, 5]. В их общей структуре вывихи являются наиболее частым, тревожным и проблематичным для лечения осложнением. В раннем послеоперационном периоде они занимают лидирующее положение [11, 15]. В литературе активно обсуждаются факторы, способствующие возникновению вывихов
Objective: to find adverse periprosthetic local tissue reactions after metal-on-metal hip arthroplasty with ASR XL heads. Material and methods: 119 patients with 134 ASR XL head - Corail prostheses were treated in 2007-2009. The results were studied in 94 cases (105 prostheses) - 84%. Average follow-up time consisted 62 ± 3 months. MRI was performed in 12 patients (13 hips) who had clinical nonsatisfaction. Obtained data were compared with 21 MRI (24 hips) of controlled group with good and perfect clinical results. Results. We found variations of normal periprosthetic tissue condition. Adverse reactions were identified in 10 cases. To improve the quality of pictures we developed special MRI adjustments and regimes of work. Conclusion: MRI diagnostics is indicated for the patients with metal-on-metal total hip arthroplasty in order to identify adverse local tissue reactions. The improvement of picture quality needs special adjustment of MRI equipment.
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