The key aspects of the study: 1) what has changed in the structure of revisions in recent years? 2) what is the spectrum of reasons for revision after primary hip arthroplasty and re-revision? 3) what are the demographic features of patients’ population undergoing the revision? Materials and methods. The authors conducted a retrospective evaluation of 2415 hip revision cases during the period of time from 2014 until 2018. Separately the authors assessed revisions after primary surgeries and re-revisions as well as the group of early revisions. Results. In the period from 2014 until 2018 the overall share of revisions was 16,6% from all total hip arthroplasties, at the same time the authors reported the absolute 1.7 times increase in number of revisions as well as increased share of revisions in the total structure of hip arthroplasty from 12,5% to 18,9% without significant variances in the number of primary procedures. The share of early revisions increased from 32.9% in 2013 to 56.7% while the number of early revisions amounted to 37.4% of all primary revisions. Gender composition in primary and revision hip arthroplasty varied insignificantly. Mean age at the moment of hip revision was 59.2% (95% CI from 58.7 to 59.7; Me 60 years) which is slightly less than in primary replacement — 60.2 years (95% CI from 58.9 to 61.1; Me 62 years), but such variances had a high statistical significance, р0.001. The main reasons for primary revisions were aseptic loosening of prosthesis components (50.3%), infection (27.6%), polyethylene wear and osteolysis (9.0%) as well as dislocations (6,2%). Re-revisions structure featured prevalence of infection (69.0%), aseptic loosening (20.8%) and dislocations (7,8%). Mean period of time after primary hip arthroplasty to revision was 7.9 years (95% CI from 7.7 to 8.2; Me 7.3), to first re-revision — 2.9 (95% CI from 2.6 to 3.2; Me 1.2), to second re-revision — 2.2 (95% CI from 1.8 to 2.7; Me 1.1), to third — 2,2 (95% CI from 1.7 to 2.8; Me 1.1), to fourth — 1.0 (95% CI from 0.6 to 1.3; Me 0.6), remaining cases demonstrated rather high heterogeneity. Conclusion. In the result of the present study the authors observed increased number of all revision hip arthroplasties, especially the share of early revisions within first five years from the moment of previous surgery. The most often reason for revision after primary hip arthroplasty was aseptic loosening of one or both components of prosthesis. Infection was the absolute leader in the group of re-revisions constituting over half of all reasons for secondary intervention.

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Introduction. The matter of the replacement of acetabular defects is becoming increasingly relevant today. In their clinic the authors used custom-made implants with trabecular coating for replacement of defects in the acetabulum where and when it was necessary to ensure extended fixation of the component. Purpose — to evaluate short-term clinical and functional outcomes, osteointegration of porous coated custom-made implants, the overall survival of structural components and to identify the causes of failures and complications. Materials and Methods. During the study the authors interviewed and evaluated radiographs of 48 patients operated from October 2015 to June 2018. The patients were interviewed before and after the surgery using the Oxford hip joint scale, quality of life EQ-5D and visual analogue pain scale. Radiographs were evaluated for a period of at least 12 months for the signs of osteointegration. Results. The average OHS scores increased from 14.9 (±7) to 37.6 (±7) (p<0.01). Quality of life according to the EQ-5D index increased from 0.2 (±0.2) to 0.7 (±0.2) (p<0.01). The average value by general health scales: before operations — 49 (±17) and 73 (±18) scores after surgeries (p<0.01). The average VAS pain score decreased from 73 (±10) to 19 (±19) points (p<0.01). Osteointegration was observed in 98 percent of cases. Migration of the implant with fracture of a flange was observed in one case. Conclusions. In the short-term follow up the use of custom-made implants significantly improves hip joint function and the patients’ life quality. Custom-made implants enable primary reliable fixation in case of complex acetabular defects. High rate of osteointegration is observed for custom-made implants with porous coating within at least 12 months. Longer follow-up is needed to evaluate long-term results.

Today in our country, the follow-up of patients after arthroplasty is carried out in accordance with clinical guidelines, the wording of which is based on monographs from 2006, 2008, and 2014, in addition, clinical guidelines for follow-up do not take into account the results of treatment assessed by the patient himself. The recommendations for surveillance in the world literature are heterogeneous. Since 2022, fixed recommendations for follow-up after arthroplasty have been used in the clinical practice of our center in discharge epicrisis. Implementation of the recommendations is carried out with the help of the developed system of remote assessment of the results with the use of web questionnaires. Recommendations for the frequency of follow-up were formulated by experts based on a comprehensive review of the literature and their own experience. In the first three months, 221 hip and 235 knee evaluation questionnaires were collected through the proposed mechanism, with a progressive increase in the number of questionnaires based on weekly monitoring data. We described the mechanism of remote monitoring of patients after arthroplasty and presented the early results of using this system. Unfortunately, the outpatient clinic system is not always able to provide qualitative monitoring of patients after arthroplasty due to various reasons, therefore, in our opinion, the implementation of the mechanism of remote monitoring of patients will allow detecting various complications at the stage of early diagnosis, which will contribute to prompt solution of these problems. The remote monitoring system is also an important source of scientific data. The increase in quantity, as well as the analysis of the incoming information will create conditions for further improvement of the system of remote monitoring of patients after arthroplasty.

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Relevance. Total hip arthroplasty with a severe dysplasia refers to complex cases of joint replacement. One of the options for fixation of the acetabular component in this situation is to place the cup in the false acetabulum. Revisions in case of the acetabular component initial placement into the false acetabulum are highly complex. The purpose -to study the features of revision hip arthroplasty in the patients with dysplastic arthritis and loosening of the acetabular component initially placed in the false acetabulum. Materials and Methods. The clinical and functional results and complications were evaluated after 44 revisions performed by one surgical team from 2001 to 2019. How the position of vertical and horizontal centers of rotation of acetabular component after primary arthroplasty influenced the long-term survival of implants was analyzed. The degree of impact of the preoperative cranial displacement from the anatomical position of the femoral component center of rotation impact on surgical tactics was also investigated. Results. A combination of a highly porous cup with augment was used most frequently for acetabular component replacement (24 cases; 54.5%). Complications after the revision were detected in 6 (13.6%) patients. The values of the Oxford Hip Score, EQ-5D, VAS general health, and VAS pain depended on the postoperative position of the hip prosthesis center of rotation within 10 mm from the anatomical center. The odds ratio for the revision performed less than 10 years after the primary arthroplasty in the patients with a horizontal position of the center of rotation of 40 mm or more was equal to 14.571 (95% CI from 1.682 to 126.249; p = 0.011). The average value of the distal displacement of the center of rotation after the surgery was 32.0 mm (min-max 4.7 to 90.3 mm; Me 23.9 mm), the average residual displacement of the center of rotation after the surgery was 6.2 mm (min-max 10.8 to 32.1 mm; Me 4.75 mm). The standard approach was characterized by a lesser distal displacement of the center of rotation than various osteotomy options: 26.1 mm (min-max 4.7 to 77.2; Me 19.1 mm) vs 41.2 mm (min-max 10.8 to 90.3 mm; Me 36 mm), respectively (p = 0.021). A well-fixed stem preservation resulted in the mean distal displacement of the femur of 23.8 mm, the stem removed -of 35.0 mm. Conclusion. A horizontal center of rotation displacement of 40 mm or more affects the long-term survival of the implant. When the significant lowering of the femur is required (more than 30 mm) and a well-fixed femoral component is preserved, it is advisable to use the approach with extended trochanteric osteotomy or shortening femoral osteotomy. The acetabular component placement into the true acetabulum with weakened bone requires extended screw fixation. In this situation the use of individual 3D-printed implants has potential benefits.

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Данная статья посвящена оценке точности позиционирования компонентов эндопротеза коленного сустава у пациентов, оперированных с использованием индивидуальных резекторных блоков. Все пациенты проходили хирургическое лечение в РНИИТО им. Р.Р. Вредена с 2017 по 2018 гг., операции выполнялись опытными хирургами, проводящими более 60 операций в год. Все пациенты были разделены на две группы: основная группа-30 пациентов, прооперированных с использованием индивидуальных резекторных блоков; контрольная группа-15 пациентов, прооперированных с использованием стандартной техники. Технология производства индивидуальных резекторных блоков включала в себя следующие этапы. 1. Компьютерная томография нижних конечностей с захватом трех суставов: тазобедренного, коленного, голеностопного. 2. Планирование осей конечности и плоскостей опилов совместно с оперирующим хирургом. 3. Построение трехмерной модели оперируемой нижней конечности: в программе 3Dslicer производилось сегментирование костей нижней конечности, далее в программе Blender определялись референтные линии. 4. Трехмерная печать индивидуальных резекторных блоков. Средние значения отклонений от механической оси нижней конечности составили 1,1 градуса (от 0,3 градуса вальгусной деформации до 2,6 градуса варусной деформации) для пациентов основной группы, 2,5 градуса (от 0,8 градуса вальгусной деформации до 4,2 градуса варусной деформации) у пациентов контрольной группы. При использовании непараметрического метода Манна-Уитни не было выявлено различий в средних значениях отколонения от механической оси нижней конечности. Индивидуальные резекторные блоки показывают результаты, сопоставимые со стандартной техникой в руках опытных хирургов, и могут быть рекомендованы к использованию начинающими хирургами. Ключевые слова: эндопротезирование, коленный сустав, индивидуальные резекторные блоки.