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Backround. Total hip replacement in cases of traumatic changes of the acetabulum refers to cases of difficult primary arthroplasty and requires detailed preoperative planning and accurate restoration of anatomical relationships in the operated joint. The aim of the study was to evaluate the structure of pathological changes in the acetabulum in patients with posttraumatic hip arthrosis, to develop a method for their detailed description and to determine the tactics of choosing the type of acetabulum implant. Methods. The results of treatment of 194 patients with the consequences of acetabulum fractures who underwent total hip arthroplasty in the period from 2014 to 2022 were analyzed. The study was conducted in two stages, at the first stage, the structure of pathological changes, such as defect, deformation, changes in the center of rotation and offset (relatively healthy contralateral joint), was analyzed. A method was developed for choosing the tactics of implantation of the acetabulum component, based on a detailed description of the defect and deformation of the acetabulum. The second stage analyzed the results of treatment of patients for whom planning and surgical treatment was carried out in the period from 2020 to 2022 using the proposed method. Results. During the first stage of the study, it was revealed that the magnitude of the change in the indicators of the displacement of the rotation center and offset changes by more than 8 mm. statistically significantly increases the likelihood of complications by 17.9%. The restoration of the rotation and offset center reduces the number of complications by 22.3%. The proposed method makes it possible to statistically reliably restore anatomical relationships in the operated hip joint and reduce the number of complications by 10%. Conclusion. The proposed method allows us to qualitatively and quantitatively describe pathological changes in the bone tissue of the acetabulum. Depending on the degree of displacement of the center of rotation, the walls of the acetabulum and the nature of the defect of the supporting bone tissue, the surgeon can determine the tactics of surgical treatment.
Backround. Total hip replacement in cases of traumatic changes of the acetabulum refers to cases of difficult primary arthroplasty and requires detailed preoperative planning and accurate restoration of anatomical relationships in the operated joint. The aim of the study was to evaluate the structure of pathological changes in the acetabulum in patients with posttraumatic hip arthrosis, to develop a method for their detailed description and to determine the tactics of choosing the type of acetabulum implant. Methods. The results of treatment of 194 patients with the consequences of acetabulum fractures who underwent total hip arthroplasty in the period from 2014 to 2022 were analyzed. The study was conducted in two stages, at the first stage, the structure of pathological changes, such as defect, deformation, changes in the center of rotation and offset (relatively healthy contralateral joint), was analyzed. A method was developed for choosing the tactics of implantation of the acetabulum component, based on a detailed description of the defect and deformation of the acetabulum. The second stage analyzed the results of treatment of patients for whom planning and surgical treatment was carried out in the period from 2020 to 2022 using the proposed method. Results. During the first stage of the study, it was revealed that the magnitude of the change in the indicators of the displacement of the rotation center and offset changes by more than 8 mm. statistically significantly increases the likelihood of complications by 17.9%. The restoration of the rotation and offset center reduces the number of complications by 22.3%. The proposed method makes it possible to statistically reliably restore anatomical relationships in the operated hip joint and reduce the number of complications by 10%. Conclusion. The proposed method allows us to qualitatively and quantitatively describe pathological changes in the bone tissue of the acetabulum. Depending on the degree of displacement of the center of rotation, the walls of the acetabulum and the nature of the defect of the supporting bone tissue, the surgeon can determine the tactics of surgical treatment.
BACKGROUND: Neurological complications in sciatic nerve (SN) after a total hip replacement (THR) are observed in 0.93.2% of cases in patients with arthrosis deformans and age-related morphologic changes in SN. These cause the need for SN evaluation before THR. This research was aimed at the evaluation of the initial SN capacity with electrophysiological findings in patients with arthrosis deformans of the hip. MATERIALS AND METHODS: Electroneuromyography (ENMG) was used to evaluate fibular and tibial nerves M-responses as well as F-waves in 66 patients with dysplastic coxarthrosis and 12 patients with posttraumatic coxarthrosis. The findings were compared to those of the controls. RESULTS: Changes in ENMG findings for fibular nerve in 49 patients with dysplastic coxarthrosis were bilateral and showed significant difference only from the norm. In 19 of 66 cases (27.9%) low M-responses (р 0.02) were found in the side subject to THR. In 87.3% of cases, the signs of a decrease in the conductivity of proximal segments of the tibial nerve were revealed. In patients with posttraumatic coxarthrosis, the significant decrease in ENMG findings from both fibular and tibial nerves was observed in the affected side, they made up just 42-50% of those in the opposite side. Asymptomatic progress of denervation damage in hip and tibia muscles sometimes required needle EMG to fund the signs of motor innervation disorder. A-waves revealed in 65% of patients suggested local damage to one or both portions of SN. CONCLUSION: ENMG findings in patients with dysplastic arthrosis of the hip enabled revealing of the signs of neuropathy before surgeries and decreasing the risk of neurologic post-surgery complications.
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