Optimization of surgical access in hip arthroplasty

Abstract

Relevance. Total hip joint arthroplasty with a wide range of both classical and modifi ed approaches is a successful method of treating joint diseases in the fi nal stages. It should be noted that in recent years, there has been an increased interest among scientists — specialists in this fi eld — in developing and implementing new, more optimal approaches for primary and revision arthroplasty.Research objective: to determine the advantages and disadvantages of surgical approaches in arthroplasty of the hip joint in patients with dysplastic coxarthrosis.Material and methods. For this study, we observed 80 patients (18 men, 16 women) aged 45 to 60 years with dysplastic coxarthrosis of the hip joint who were undergoing treatment in the trauma and orthopedics department of the therapeutic surgical clinic of the Azerbaijan Medical University. The comparison group included 25 patients who underwent total hip joint arthroplasty from a posterior-lateral approach; 25 control group patients underwent surgery with a Harding approach, and 30 main group patients underwent surgery from the proposed modifi ed approach. All approaches were performed as indicated. Before and 6 and 12 months after arthroplasty, the WOMAC index, C-reactive protein level, and ESR in the blood were studied in patients.Results. In the control group, some positive dynamics of clinical and biochemical indicators were noted at 6 and 12 months, but their values did not diff er signifi cantly from those of the comparison group (p > 0.05), but were signifi cantly higher than those of the main group (p < 0.001). Analysis of arthroplasty outcomes revealed a higher percentage of positive clinical outcomes with a signifi cant reduction in WOMAC index values and a decrease in C-reactive protein and ESR levels when using minimally invasive surgical techniques. Thus, the anterior approach with low intraoperative trauma is more optimal for patients with dysplastic coxarthrosis, as it promotes faster functional recovery and causes fewer infl ammatory complications. The posterior-lateral approach, like the anterior one, is optimal, since the above indicators did not diff er signifi cantly from those of the anterior approach. With the lateral approach, due to a higher risk of wound infection, the recovery time and reduction of the infl ammatory reaction are longer.