Hip Replacement Surgery Research Articles

Ultrasound monitoring to detect embolic phenomena in the inferior vena cava during hip arthroplasty

Introduction and objectivesEmbolic phenomena frequently occur during hip joint replacement surgery, and may lead to haemodynamic instability in frail patients. Transoesophageal ultrasound monitoring is rarely available in non-cardiac operating theatres, and cannot be performed in awake patients under spinal anaesthesia. The main objectives of this prospective exploratory study were to determine the feasibility of using an alternative ultrasound approach to monitor the inferior vena cava during hip replacement surgery, and to determine the intra and interobserver reliability of the ultrasound findings. MethodWe conducted a prospective exploratory study in 20 patients undergoing cemented hip arthroplasty in the supine position under spinal anaesthesia and sedation. The inferior vena cava was assessed through a subcostal window at 10 intraoperative time points, and the findings were rated on a qualitative embolism severity scale. The ultrasound images were evaluated by 2 independent observers. ResultsAn adequate subcostal window was obtained in 90% of cases. Intra- and inter-observer reliability was high (kappa index >0.80, p < 0.001). Nearly all (95%) patients presented some degree of embolism, which was severe in 50% of cases. ConclusionsOur study suggests that ultrasound assessment of embolic phenomena in the inferior vena cava through a subcostal window is feasible in 90% of cases. The qualitative embolic severity rating scale is highly reproducible and has high intra- and inter-observer reliability.

Groove design optimization of femoral heads in solid hip implants: Study on stress distribution and total deformation using FEA and full factorial design

Hip replacement surgery is a common procedure that relies on the implant's design to withstand daily activities. This study aims to investigate the impact of different surface groove designs on the performance of solid hip implants using finite element analysis (FEA) and optimization techniques. The study evaluates the influence of grooves on the stress distribution and total deformation of the implant, considering three designs: no grooves, horizontal grooves, and vertical grooves on the surface of the femoral head. The simulations were conducted using Ansys Mechanical, and the optimization process was carried out using the general full factorial design method in Minitab software. The results demonstrate that the groove design significantly affects the stress distribution and wear of the implant. The vertical groove design shows better overall results, indicating the best performance. The study also evaluated the influence of force on the performance of the implant, with different load range. The optimization process using the general full factorial design method revealed that the optimal groove design was a vertical model with an optimized groove depth and width. These findings offer valuable insights into the impact of surface groove designs on the performance of solid hip implants, leading to better patient outcomes and longer implant lifespan. Overall, this study provides a comprehensive understanding of the effect of surface groove design on the performance of solid hip implants.

Comparative analysis of the quality of life regarding patients who underwent hip replacement in public versus private hospitals in Hungary

The study aimed to investigate the impact of hip replacement surgery on the quality of life and to compare the outcomes by sociodemographic and surgical data in Hungarian public and private hospitals. Patients were selected at the Department of Orthopaedics (Clinical Centre, University of Pécs) and at the Da Vinci Private Clinic in Pécs. Patients completed the SF-36 and Oxford Hip Score (OHS) questionnaires before the surgery, 6 weeks and 3 months later. We also evaluated socio-demographic data, disease and surgical conditions. The research involved 128 patients, 60 patients in public, 68 patients in private hospital. Despite the different sociodemographic characteristics and surgical outcomes of public and private healthcare patients, both groups had significantly improved the quality of life 3 months after hip replacement surgery measured by OHS and SF-36 physical health scores (p < 0.001). In the mental health score, only the patients of the private health sector showed a significant improvement (p < 0.001). The extent of improvement did not differ between the two healthcare sectors according to the OHS questionnaire (p = 0.985). While the SF-36 physical health score showed a higher improvement for public patients (p = 0.027), the mental health score showed a higher improvement for private patients (p = 0.015).

Clinical application of LARS tumor tube in joint function reconstruction of tumor type artificial hip replacement.

Proximal femur tumor resection often leads to hip joint instability and functional loss. Various methods have been clinically applied to repair hip joint soft tissue function, but deficiencies remain. This study aims to evaluate the advantages and disadvantages of the ligament advanced reinforcement system (LARS) tumor tube in assisting soft tissue function reconstruction in patients undergoing tumor type artificial hip replacement surgery. This study included 85 patients (41 males, 44 females) with proximal femoral tumors treated at the Xiangya Bone Tumor Treatment Center from January 2012 to January 2022, aged 10 to 79 (38.5±18.2) years. Among them, 13 cases had benign aggressive tumors, 45 had primary malignant bone tumors, and 27 had bone metastases. Clinical data, imaging data, and intraoperative photos were collected. Patients were followed up and postoperative functional evaluations were conducted using the Musculoskeletal Tumor Society (MSTS) scoring system and Harris hip joint scoring system to assess limb function and hip joint function. Preoperative pathological fractures were present in 37 cases (43.5%), with a lesion length of (9.4±2.9) cm. Among non-metastatic tumor patients, 7 experienced postoperative recurrence, including 6 cases of osteosarcoma and 1 case of fibrosarcoma. Pulmonary metastases occurred in 9 osteosarcoma patients. Five patients required reoperation due to postoperative complications, including 3 cases of deep vein thrombosis, 1 case of giant cell granuloma, and 1 case of prosthesis infection. Postoperatively, 5 patients exhibited Trendelenburg gait, and 6 had leg length discrepancies. The postoperative MSTS score was 26.7±1.4, and the Harris score was 89.6±5.3. The LARS tumor tube can effectively assist in reconstructing the soft tissue function of the hip joint and greatly reduce postoperative complications, making it an effective technical improvement in joint function reconstruction in tumor type artificial hip replacement surgery.

Mechanisms and Preventative Strategies for Persistent Pain following Knee and Hip Joint Replacement Surgery: A Narrative Review.

Chronic postsurgical pain (CPSP) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) is a prevalent complication of joint replacement surgery which has the potential to decrease patient satisfaction, increase financial burden, and lead to long-term disability. The identification of risk factors for CPSP following TKA and THA is challenging but essential for targeted preventative therapy. Recent meta-analyses and individual studies highlight associations between elevated state anxiety, depression scores, preoperative pain, diabetes, sleep disturbances, and various other factors with an increased risk of CPSP, with differences observed in prevalence between TKA and THA. While the etiology of CPSP is not fully understood, several factors such as chronic inflammation and preoperative central sensitization have been identified. Other potential mechanisms include genetic factors (e.g., catechol-O-methyltransferase (COMT) and potassium inwardly rectifying channel subfamily J member 6 (KCNJ6) genes), lipid markers, and psychological risk factors (anxiety and depression). With regards to therapeutics and prevention, multimodal pharmacological analgesia, emphasizing nonopioid analgesics like acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), has gained prominence over epidural analgesia. Nerve blocks and local infiltrative anesthesia have shown mixed results in preventing CPSP. Ketamine, an N-methyl-D-aspartate (NMDA)-receptor antagonist, exhibits antihyperalgesic properties, but its efficacy in reducing CPSP is inconclusive. Lidocaine, an amide-type local anesthetic, shows tentative positive effects on CPSP. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) have mixed results, while gabapentinoids, like gabapentin and pregabalin, present hopeful data but require further research, especially in the context of TKA and THA, to justify their use for CPSP prevention.

Comparison of Intra-Articular and Intravenous Tranexamic Acid for Loss of Blood in Patients Undergoing Total Hip Replacement

Background: Tranexamic acid (TXA) is widely used in orthopedic surgeries to minimize blood loss, traditionally administered intravenously. Recent studies have explored intra-articular (IA) administration as a potentially more effective method due to its localized application and reduced systemic absorption. Objective: To compare the effectiveness of IA and IV TXA in reducing blood loss in patients undergoing total hip replacement (THR). Methods: This randomized controlled trial was conducted at Jinnah Hospital, Lahore, from August 30, 2019, to February 29, 2020, with approval from the Ethical Review Board. Seventy patients undergoing THR were enrolled and divided into two groups using a lottery system. Group A (n=35) received 1500 mg of IA TXA diluted in 100 ml of saline after implantation of THR components, while Group B (n=35) received 15 mg/kg of IV TXA five minutes before incision. Both groups were operated on using a lateral approach by the same surgeon. Postoperative blood loss was measured, and data were analyzed using SPSS version 20, with a p-value of &lt;0.05 considered significant. Results: The mean total blood loss in Group A was significantly lower at 446.23 ± 33.81 ml compared to Group B, which had a mean of 928.23 ± 43.93 ml (p-value = 0.0001). The results highlighted a marked reduction in blood loss with IA administration compared to IV. Conclusion: IA administration of TXA during THR is more effective than IV administration in reducing total blood loss. This study supports the use of IA TXA as a safer, more efficient method for managing blood loss during hip replacement surgeries.

Risk and complication profiles of orthogeriatric patients in elective hip and knee joint replacement

The care of geriatric patients undergoing elective orthopedic surgery is becoming increasingly more important due to demographic trends. Compared to geriatric traumatology, however, there are still no established orthogeriatric care models in Germany and therefore hardly any scientific data. The aim of this study was to describe the risk and complication profiles in older patients with elective hip and knee replacements. In aprospective study data were collected from orthogeriatric patients with indications for elective hip and knee replacement surgery who fulfilled defined inclusion and exclusion criteria between January 2021 and August 2023 in the orthopedic department of aGerman university hospital for the descriptive analysis of risk and complication profiles. In addition to apreoperative and perioperative data analysis, afollow-up was conducted 4-6weeks and 3months postoperatively. The surgical risk profile of the patient population analyzed was characterized by advanced age (78.4 ± 4.8years), preobesity/obesity (76%), multimorbidity (7.4 ± 3.1 comorbidities), polypharmacy (7.5 ± 3.8 medications), immobility (short physical performance battery 7.1 ± 2.6), prefrailty/frailty (87%), frequent anticoagulation (22%) and ahigh number of potentially inappropriate medications (64%). Complication events mainly occurred within the first 7days postoperatively and 90% of the events within this recording period were minor complications. The overall complication rate significantly decreased in the follow-up period. Due to the high risk and complication profiles the routine use of orthogeriatric co-management models for elective orthopedic surgery should be considered in the future.

The course of the early recovery period after total arthroplasty in patients with diabetes

More than 20% of patients undergoing total joint arthroplasty (TJA) have diabetes mellitus (DM), which is one of the risk factors for complications in the postoperative period. The aim: to determine the peculiarities of the course of the postoperative period in patients with diabetes after TJA, in particular, after hip and knee arthroplasty (HKA). Materials and methods. A retrospective analysis of the inpatient charts of 50 patients who underwent HKA operations against the background of concomitant DM was performed. All patients were divided into two groups: 1) patients with hip arthroplasty, 2) patients with knee arthroplasty. The course of the intraoperative and postoperative (p/o) periods and the development of complications were analyzed. The results. All patients were aged from 38 to 86 years, had increased weight (BMI — 26.0-29.42 kg/m). Among the complications, arterial hypertension was most often observed (in groups 64.0% and 68.0%, respectively), nausea and vomiting were often observed (32.0% and 28.0%, respectively), disturbances in the rhythm and depth of breathing (16.0% and 20.0% respectively). The need for analgesia in the p/o period was 96.0% and 100.0% of patients, which indicates insufficient quality of analgesia. Other clinical and anamnestic indicators, the course of the perioperative period and the development of complications were similar in patients undergoing both hip and knee replacement surgeries (p&gt;0.05). Conclusions. Clinical and anamnestic data, the spectrum of existing concomitant pathology, characteristics of carbohydrate metabolism and its disorders, features of the course of the perioperative period and detected complications were of the same type in patients regardless of the location of the intervention. There was no significant difference in the studied parameters (p&gt;0.05). Identified complications and insufficient effectiveness of p/o analgesia dictates the need to find optimal methods of perioperative analgesia during HKA operations.

β-hydroxybutyrate exposure restores mitochondrial function in skeletal muscle satellite cells of critically ill patients

Background and AimDysfunction of skeletal muscle satellite cells might impair muscle regeneration and prolong ICU-acquired weakness, a condition associated with disability and delayed death. This study aimed to elucidate the distinct metabolic effects of critical illness and β-OHB on satellite cells isolated from these patients. MethodsSatellite cells were extracted from vastus lateralis muscle biopsies of patients with ICU-acquired weakness (n = 10) and control group of healthy volunteers or patients undergoing elective hip replacement surgery (n = 10). The cells were exposed to standard culture media supplemented with β-OH-butyrate to assess its influence on cell proliferation by ELISA, mitochondrial functions by extracellular flux analysis, electron transport chain complexes by high resolution respirometry, and ROS production by confocal microscopy. ResultsCritical illness led to a decline in maximal respiratory capacity, ATP production and glycolytic capacity and increased ROS production in ICU patients’ cells. Notably, the function of complex II was impaired due to critical illness but restored to normal levels upon exposure to β-OH-butyrate. While β-OH-butyrate significantly reduced ROS production in both control and ICU groups, it had no significant impact on global mitochondrial functions. ConclusionCritical illness induces measurable bioenergetic dysfunction of skeletal muscle satellite cells. β-OH-butyrate displayed a potential in rectifying complex II dysfunction caused by critical illness and this warrants further exploration.

Older patients’ experiences of person-centred integrated care: joint replacement surgery as a case

PurposeIntegrated care (IC) is mainly studied from the perspectives of organisations or employees. However, less research is focussed on how patients themselves experience person-centred (PC) IC in practice. This context-specific, small-scale study examines what PC-IC means to older patients who went through joint replacement surgery (JRS).Design/methodology/approachThe data consists of ten in-depth interviews of older patients, focussing on their experiences of care during their patient journey related to joint knee or hip replacement surgery. The data were analysed with thematic analysis.FindingsThree central dimensions of PC-IC for older patients were identified: information sharing, continuity of care and compassionate encountering. Human validation and compassionate encountering were experienced as important aspects of PC-IC. Compassionate encountering was concretised through professionals’ very small everyday practices, which made the patient feel comfortable and respected. Instead, probably due to the medical and quite straight-forward nature of the joint replacement care process, patients seem to be pleased to trust the expertise of professionals and did not necessarily expect an active role or participation in the decision-making.Originality/valueThis Finnish case study focusses on the patients’ authentic perceptions of what is central to person-centred IC in the specific context of JRS.

Image Based vs Imageless Robot in Hip Replacement Surgery

Image Based vs Imageless Robot in Hip Replacement Surgery

Dexmedetomidine Effects on Surgical Stress Hormones

Background: Increased levels of cortisol and catecholamines are the reaction to tissue damage due to surgical trauma. Dexmedetomidine inhibits the synthesis of these two hormones.Objective: This study aimed to prove that dexmedetomidine reduces the endocrine response to surgical stress.Method: 40 patients who underwent Total Knee or Hip Replacement surgery with regional anesthesia were involved in the Double-Blind Randomized Controlled Trial Pre-Test – Post-Test Design, which was divided into two research groups: the therapy group and the control group. Changes in the body's response to stress during surgery were compared by assessing blood cortisol levels, heart rates (HRs), and mean arterial pressures (MAPs). The Beck Depression Inventory (BDI) was used to evaluate the level of depression. The numeric rating scale is used to evaluate perioperative pain, while the Ramsay scale is used to measure the level of sedation. Data analysis was carried out using the Statistical Program for Social Sciences (SPSS).Results: The cortisol levels of the therapy group compared to the control group (p = 0.016) decreased significantly immediately after surgery. Hemodynamic changes in the study, the heart rate (p=0.001), and mean arterial pressure (p=0.000) were significantly lower than the control group.Conclusion: Administration of dexmedetomidine during the surgical period reduces stress hormone responses. These results indicate that dexmedetomidine administration is good to apply, especially in TKR/THR.

Robot-assisted surgery and artificial intelligence-based tumour diagnostics: social preferences with a representative cross-sectional survey

BackgroundThe aim of this study was to assess social preferences for two different advanced digital health technologies and investigate the contextual dependency of the preferences.MethodsA cross-sectional online survey was performed among the general population of Hungary aged 40 years and over. Participants were asked to imagine that they needed a total hip replacement surgery and to indicate whether they would prefer a traditional or a robot-assisted (RA) hip surgery. To better understand preferences for the chosen method, the willingness to pay (WTP) method was used. The same assessment was conducted for preferences between a radiologist’s and AI-based image analysis in establishing the radiological diagnosis of a suspected tumour. Respondents’ electronic health literacy was assessed with the eHEALS questionnaire. Descriptive methods were used to assess sample characteristics and differences between subgroups. Associations were investigated with correlation analysis and multiple linear regressions.ResultsAltogether, 1400 individuals (53.7% female) with a mean age of 58.3 (SD = 11.1) years filled in the survey. RA hip surgery was chosen by 762 (54.4%) respondents, but only 470 (33.6%) chose AI-based medical image evaluation. Those who opted for the digital technology had significantly higher educational levels and electronic health literacy (eHEALS). The majority of respondents were willing to pay to secure their preferred surgical (surgeon 67.2%, robot-assisted: 68.8%) and image assessment (radiologist: 70.9%; AI: 77.4%) methods, reporting similar average amounts in the first (p = 0.677), and a significantly higher average amount for radiologist vs. AI in the second task (p = 0.001). The regression showed a significant association between WTP and income, and in the hip surgery task, it also revealed an association with the type of intervention chosen.ConclusionsIndividuals with higher education levels seem to accept the advanced digital medical technologies more. However, the greater openness for RA surgery than for AI image assessment highlights that social preferences may depend considerably on the medical situation and the type of advanced digital technology. WTP results suggest rather firm preferences in the great majority of the cases. Determinants of preferences and real-world choices of affected patients should be further investigated in future studies.

[Translated article] Vancomycin powder in the prevention of infection in primary knee and hip arthroplasty: Case–control study with 1151 arthroplasties

Background and objectiveVancomycin powder (VP) has been positively used in spinal surgery to reduce the rate of infections. Hardly any data have been published on hip and knee joint replacement surgery, and its usefulness is questioned. Our objective was to investigate the effectiveness of VP in reducing prosthetic infection and its possible complications. MethodsPrimary hip (THA) and knee (TKA) arthroplasties were reviewed, performed by five surgeons in one hospital centre, between 2017 and 2018. One gram of VP was used on the implant prior to surgical closure based on the surgeon's preferences. With a 5-year follow-up in which the infection rate and local complications were analysed. ResultsOne thousand one hundred and fifty-one arthroplasties were performed, 748 were TKA and 403 were THA. Nine patients were diagnosed with prosthetic infection, of which five received VP and four did not (p=0.555). Likewise, another 15 patients suffered wound complications, of which 11 received VP and 4 did not (p=0.412). There were no differences, either, in the rest of the complications depending on the use or not of VP (p=0.101). Likewise, the number of patients who needed reintervention was similar (p=0.999).No systemic complications were detected due to the use of VP. ConclusionsIt has not been possible to demonstrate that the use of VP reduces the rates of prosthetic infection in the hip and knee, so we cannot recommend its use.

A retrospective review of effectiveness of ERAS post-operative pain protocol in hip replacement surgeries under general anaesthesia at a tertiary orthopaedic hospital

: The concept of enhanced recovery after surgery (ERAS) was first introduced in 1997 by a group of European surgeons led by Henrik Kehlet. The ERAS concept was introduced to target the factors delaying post-operative recovery such as organ dysfunction, surgical stress and to improve the surgical outcomes and length of stay at the hospital. The primary aim of this approach is to reduce the body’s response to surgical stress by implementing a multidisciplinary, multitude of interventions in a coordinated clinical pathway. It was first implemented for colorectal surgeries to improve the post-surgical recovery rates by decreasing the post-operative ileus and thereby reducing the cost and length of hospital stay. Since the successful introduction of the program, ERAS has been used in several other specialties such as breast, urological, gynaecological, and musculoskeletal procedures. Off-late ERAS has become important in orthopaedic surgeries, particularly elective hip and knee arthroplasties. A retrospective review audit was conducted at tertiary Orthopaedic NHS Hospital to determine the effectiveness of ERAS post-operative pain protocol in patients who had primary hip arthroplasty under general anaesthesia. The qualitative and quantitative data included the length of stay at the hospital and default rates in the ERAS pain protocol. The length of stay at the hospital in ERAS compliant group was a mean of 3.95 days and in ERAS default group was 4.7 days, showing an increase of 16% in the total duration. The IV PCA group had 4.6 days of the average length of stay.: ERAS pathway advocates for using opioid-sparing multimodal analgesia to control pain, peripheral nerve blocks (single-shot/continuous), and local infiltration /peri-articular injections have become a better alternative to opioids in controlling the immediate post-surgical pain effectively. There is clear evidence to suggest that these techniques can improve patient outcomes and decrease the duration of stay.

Equity in the recovery of elective and oncological surgery volumes after the COVID-19 lockdown: a multicentre cohort study in Italy

BackgroundThe COVID-19 pandemic has had, and still has, a profound impact on national health systems, altering trajectories of care and exacerbating existing inequalities in health. Postponement of surgeries and cancellation of elective surgical procedures have been reported worldwide. In Italy, the lock-down measures following the COVID-19 pandemic caused cancellations of surgical procedures and important backlogs; little is known about potential social inequalities in the recovery process that occurred during the post-lockdown period. This study aims at evaluating whether all population social strata benefited equally from the surgical volumes’ recovery in four large Italian regions.MethodsThis multicentre cohort study covers a population of approximately 11 million people. To assess if social inequalities exist in the recovery of eight indicators of elective and oncological surgery, we estimated Risk Ratios (RR) through Poisson models, comparing the incidence proportions of events recorded during COVID-19 (2020-21) with those in pre-pandemic years (2018-19) for each pandemic period and educational level.ResultsCompared to 2018-19, volumes of elective surgery showed a U-shape with the most significant drops during the second wave or the vaccination phase. The recovery was socially unequal. At the end of 2021, incidence proportions among highly educated people generally exceeded the expected ones; RRs were 1.31 (95%CI 1.21–1.42), 1.24 (95%CI 1.17–1.23), 1.17 (95%CI 1.08–1.26) for knee and hip replacement and prostatic surgery, respectively. Among low educated patients, RR remained always < 1. Oncological surgery indicators showed a similar social gradient. Whereas volumes were preserved among the highly educated, the low educated were still lagging behind at the end of 2021.ConclusionsSurgical procedures generally returned to pre-pandemic levels but the low educated experienced the slowest recovery. An equity-oriented appraisal of trends in healthcare provision should be included in pandemic preparedness plans, to ensure that social inequalities are promptly recognised and tackled.

Pericapsular nerve group block and lateral femoral cutaneous nerve block versus fascia iliaca block for multimodal analgesia after total hip replacement surgery: A retrospective analysis.

Optimal pain control with limited muscle weakness is paramount for a swift initiation of physical therapy and early discharge. Fascia iliaca compartment block (FICB) has been recommended since it offers good pain control with a low risk of motor block. Pericapsular nerve group (PENG) block with lateral femoral cutaneous block (LFCN) has been proposed as an effective alternative to FICB that offers better pain control with a considerably lower risk of motor block. We aimed to compare the aforementioned blocks and determine which one yielded the lowest numeric rating scale (NRS) score. We designed a retrospective analysis of patients undergoing elective total hip arthroplasty. The primary outcome was the NRS score at 6, 12, and 24 hours. The secondary outcomes were total opioid consumption, time to first PRN opioid, and time to first postoperative ambulation. 52 patients were recruited, (13 PENG plus LFCN, 39 FICB). PENG plus LCFN resulted in a lower NRS at all three-time points (mean difference and 95%CI at 6 h 0.378 [-0.483; 1.240], at 12 h 0.336 [-0.378; 1.050], and at 24 h 0.464 [0.013; 0.914] P = 0.02). Moreover, less PRN opioids were requested in the PENG plus LCFN vs. FICB group (0 [0;7.5] vs 60 [15;80] milligrams of morphine equivalents, P = 0.001). No delay in the first ambulation or initiation of physical rehabilitation was reported in either group. PENG plus LCFN seems to offer better pain control and lead to less PRN opioids. Neither block hindered physical therapy nor ambulation. These results need to be confirmed with a larger prospective and randomized study.

Loosened hip joint prosthesis-decision options

For the period 2013-2015, 36 patients underwent revision surgery because of secondary developed complications after primary hip joint replacement surgery. 14 of them were male and 23 – female, with average age 73 years. &#x0D; We examined 4 groups of patients depends on the complications type:&#x0D; - Aseptic loosening in 23 patients, appeared 10 years’ average following primary hip prosthesis surgery.&#x0D; - Septic loosening in 2 patients revealed on second to the tenth month post operatively. In two other patients we observed infected hematoma.&#x0D; - Hip joint prosthesis (luxation) because of trauma or extremely wrong motion we notice in 5 patients. In one of them we revealed acetabular cup malposition.&#x0D; - Periprosthetic fractures with aseptic loosening in 3 patients.&#x0D; All 36 patients had primary cemented hip joint prosthesis.&#x0D; In the first group depends on which prosthesis parts were loosened we did acetabular cup and femoral stem replacement in 15 patients, only acetabular cup replacement in 4 patients and in 3 patients only femoral stem replacement.&#x0D; In 2 patients from second group we replaced the primary prosthesis by total spacer for 8 months followed by revision prosthesis surgery. In 2 haematoma patients we performed debridement, lavage-drainage and long term antibiotic treatment.&#x0D; In 2 patients of third group we replaced the primary head with a longer one and in 3 other patients we replaced the primary acetabular cup by shoulder collar cemented cup.&#x0D; In 2 patients of fourth group we replaced the primary acetabular cup and femoral stem by shoulder collar cemented cup and by revisionary stem delivered by Implant and Zimmer (Revitan). In the third patient we implanted revisionary femoral stem (Implant).&#x0D; 3 years after revisionary hip joint prosthesis surgery we monitor good prosthesis stability and good functional scores

ОЦЕНКА РЕЗУЛЬТАТОВ РЕВИЗИОННОГО ЭНДОПРОТЕЗИРОВАНИЯ ТАЗОБЕДРЕННОГО И КОЛЕННОГО СУСТАВОВ ПРИ ПЕРИПРОТЕЗНОЙ ИНФЕКЦИИ

Background. Periprosthetic infection is a serious complication of large joint replacement surgery. To date, there is no consensus on the choice of surgical tactics for treating this category of patients. The aim of the work. To determine the effectiveness of one-stage and two-stage revision hip and knee replacement surgery in reducing periprosthetic infection. Materials and methods. We analyzed the results of revision replacement surgery in 78 patients with deep periprosthetic infection of the hip and knee joints. In 38 patients, one-stage revision replacement surgery was used, in 40 patients – two-stage. Treatment results were assessed 1 year after the surgery. Out of 78 patients, in 45 (57.7 %) choosing the type of revision replacement surgery was made according to the algorithm developed at the Irkutsk Scientific Centre of Surgery and Traumatology. Results. Using revision replacement surgery made it possible to stop the infectious process in 64.1 % of patients. The best results were obtained after two-stage revision surgery, in which relief of the infectious process was achieved in 72.5 % of cases. The choice of treatment tactics for patients according to the algorithm improved the results of two-stage revision joint replacement surgery up to 87.5 %. Using the criteria proposed in the algorithm when assessing the positive and negative results of revision surgery made it possible to confirm the effectiveness of the algorithm in 80% of patients and to identify the probable reasons for the maintenance of periprosthetic infection: incorrect choice of the type of surgery, the presence of extensive bone defects, the presence of polyallergy. Conclusion. Analysis of the results of revision arthroplasty for periprosthetic infection made it possible to confirm the effectiveness of the proposed algorithm for choosing the type of surgery, to establish the highest effectiveness of two-stage revision surgery compared to one-stage surgery, and also to determine the probable causes of negative treatment results.

Morphological Characteristics of the Vietnamese Adult Human Acetabulum Using Multiplanar Reconstruction Computed Tomography in Total Hip Replacement Surgery.

The anatomical parameters of the acetabulum vary among races and geographical regions. Multislice Computed Tomography (CT) has proven to be a practical approach to assess morphological parameters of the acetabulum. The purpose of this study was to explore morphological characteristics of the acetabulum measured by CT scans in Vietnamese adults. Thirty-five consecutive patients aged 18 years and older received indications and eligibility for total hip replacement surgery. Sixty-three acetabulum were examined with multislice computed tomographic system (CT) with multiplanar reconstruction (MPR). Measured morphometric parameters of acetabulum included acetabular inclination angle (AIA), acetabular anteversion angle (AAA), acetabular angle of sharp (AAS), sagittal acetabular angle (SAA), acetabular horizontal offset (AHO), transverse acetabular ligament anteversion (TALA), transverse acetabular ligament inclination (TALI), acetabular depth (ADe), acetabular depth ratio (ADr) and acetabular diameter (ADi). The mean values of acetabular diameter, femoral head diameter, AIA, AAA, AAS, SAA, TALA, TALI, AHO, ADe, ADr were 50.22±3.56 mm, 43.54±3.68 mm, 40.27±5.09 mm, 13.30±5.54 mm, 39.46±5.41 mm, 26.38±9.01 mm, 9.49±3.92 mm, 47.70±6.73 mm, 3.06±0.37 mm, 18.62±2.95 mm and 309.60±41.87 mm. Our initial data has showed morphological characteristics of the acetabulum in Vietnamese adults, different from the populations from other parts of world. Also, significant correlation between the orientation of the acetabulum and the transverse acetabular ligament was documented.