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    Loskutov A.Ye., Degtiar A.V., Degtiar V.A.

    EVALUATION OF THE RESULTS OF REVISION HIPARTHROPLASTY


    About the author: Loskutov A.Ye., Degtiar A.V., Degtiar V.A.
    Heading CLINICAL MEDICINE
    Type of article Scentific article
    Annotation The number of operations of total hip arthroplasty has been steadily increasing. This trend leads to a progressive increase in the number of patients who need to perform operations of revision endoprosthetics. Aseptic instability of endoprosthesis components (25-53%) is the most frequent indication for revision hip arthroplasty, less often such operations are performed due to the development of recurrent dislocations (12-21,8%), infectious complications (6-14,4%), periprosthetic fractures (8-11%) and mechanical destruction of endoprosthesis components (4-11%). The purpose of the work was a retrospective clinical and statistical analysis of the results of revision hip replacement. 583 patients were included in the follow-up group, 621 operations of revision hip replacement were performed in the period from 2000 to the present day in the Orthopedics and Traumatology Clinic of the Oblast Hospital named after I. Mechnikov (the city of the Dnieper). The average age of patients was 58.71 years, men - 235, women - 348. Cement, cementless and hybrid methods of fixing the components of the endoprosthesis were used. 439 (75,3%) of domestic components of endoprostheses ORTEN, 136 (23,3%) of imported structures were installed during the revision operations, 8 (1,4%) patients required removal of the endoprosthesis due to infectious complications. Repeated revision intervention for the follow-up period was performed in 38 (6,51%) patients. (36,8%), aseptic instability of the femoral component - 6 (15,8%), necrectomy after superficial infection - 13 (34,2%), and inadequate instability - operations, postoperative dislocation of the endoprosthesis head - 4 (10,5%) surgery, removal of the prosthesis for infectious complications - 1 (2,6%) operation. The analysis of the results of revision hip arthroplasty was carried out by studying the data of patients' medical histories, operating journals, endoprosthesis logs, as well as data from the follow-up examination of patients in the dynamics. Clinical evaluation of the results of the treatment was carried out according to the Harris evaluation scale for the hip joint (Harris W.H., 1969: Evaluation System of the Hip). In the comparative evaluation of primary and repeat audits in age groups, the largest number of primary operations falls on 31-50 years, repeated - 41-60 years in both women and men and patients of both sexes over 71 years old. The prevalence of young patients is associated with a high background level of their physical activity and as a result of a decrease in the duration of the normal functioning of the endoprosthesis. The presence of elderly and senile patients is associated with the cementitious type of fixation of the endoprosthesis used in this category of patients and the development of aseptic instability of the components. Clinical evaluation of treatment results was carried out according to the Harris evaluation scale for the hip joint. The immediate and long-term results of treatment of patients on the Harris scale after primary revision of hip arthroplasty were studied in 496 (85,1%) patients, after repeated revision intervention in 38 (100%) patients. Analyzing the clinical results of treatment of patients who underwent revision hip arthroplasty within the period from 1 to 16 years, it was noted that 425 (79,6%) patients had excellent and good results, and 100 (18,7%) had satisfactory results. Unsatisfactory results occurred in 9 (1,7%) patients and were associated with the need to remove the endoprosthesis due to infectious complications. Revision hip arthroplastyis unusual and highly individual operation in each specific case that requires a differentiated approach to the choice of methodology for revision surgery and individual selection of modern implants, that will allow to achieve good functional and anatomical results on long terms.
    Tags hipjoint, revisionhip arthroplasty, complications
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    Publication of the article «World of Medicine and Biology» №2(64), 2018 year, 062-065 pages, index UDK 616.728.2.-089.843-039.35
    DOI 10.26724/2079-8334-2018-2-64-62-65