Possibilities of Hip Arthroplasty on the Background of Impaired Bone Metabolism

Abstract

The results of clinical and X - ray monitoring in patients undergoing hip arthroplasty, in background of subcompensated bone metabolism had been analyzed . Studied the efficacy of zoledronic acid in combination with calcium and active metabolites of vitamin D3. Studied objective parameters of functional activity, the subjective perception of life quality, as well as quantitative parameters of X - ray monitoring. It is noted that short courses of antiresorptive therapy effectively influence the parameters of functional activity and quality of life. I. Relevance Currently, there is an increase in the length of life of the citizens of developed countries. In connection with this destructive - dystrophic diseases of the skeleton found widespread and important social significance. There has been an objective phenomenon of increasing requirements for quality of care and the level of social reintegration of patients with diseases of the large joints of the skeleton. In this sense, Arthroplasty has become one of the main methods of treatment of decompensated forms of degenerative diseases and injuries in hip. The widespread introduction of Arthroplasty provides effective social and household reintegration of patients. Accumulated huge experience in the world and in domestic practice of evaluating outcomes of the medical technology, interpretation of this phenomenon has led to the analysis of survival of implants, which is due to both local and general reaction of organism on artificial kinematic. It is known that patients having a background of disturbances in bone metabolism , survival of implants is significantly less, such as immuno - inflammatory disease (1). However, there is a little question on result of Arthroplasty as it depends on the quality of the bone tissue of the operated segment and mineral homeostasis of the patient as a whole. Thereby it is interesting to do systematic assessment of bone metabolism in the postoperative period in patients undergoing hip replacement. In the Russian literature describes various approaches to postoperative management of patients on the background of subcompensated bone metabolism; since some authors argue for monitoring bone metabolism and the subsequent combination of preventive antiresorptive therapy with calcium supplements, vitamin D3 metabolites, bisphosphonates (1, 2, 9, 7, 6) or strontium ranelate (4), which in their view significantly reduces the risk of aseptic loosening, while other authors consider that the need for such therapy in the early postoperative as the main role in the short and medium term plays primary stability attained in the bone implant intraoperatively (5). Foreign Literature does not give and analysis An unambiguous answer. This polarity of views reflects the lack of a common understanding of the role of local and general outcome of bone metabolism in the motor rehabilitation, as well as the pathogenesis of aseptic instability in the postoperative period which justifies the need for further study as a premorbid state of bone metabolism and its features in the postoperative period. The aim of this study was the evaluation of the effectiveness of the combined efficiency of antiresorptive therapy on rehabilitation and the physical component of life quality after hip arthroplasty. II. Material And Methods We analyzed the results of 72 patients with osteoarthritis of the hip (III - IV stage of Kellgren - Lawrence), underwent total cementless arthroplasty observed in the clinic of Traumatology and Orthopedics (Russia, Ufa) from 2011 to 2014. The average age of patients at enrollment was 63.41 years ± 12,15 SD (59 - 87 years). The prospective study included patients with T - criterion of femoral neck of operated limb in the range of - 1 to - 2,5 SD.