Introduction Survival of implants is an important indicator of improvement in the patient's quality of life. In foreign literature, the issue of implant survival finds special attention.

The aim of the work was to evaluate the efficacy and survival of an unconstrained ceramic wrist joint endoprosthesis.

Materials and methods We analysed 83 cases of total wrist arthroplasty with an unconstrained ceramic implant at long-term follow-up. At the Novosibirsk RSITO, total wrist arthroplasty was performed in 81 patients with severe changes in the wrist joint from 2011 to 2021. Two patients underwent arthroplasty on two joints. A retrospective uncontrolled cohort study was conducted which divided the hospitalized patients into three groups according to the etiological cause of the disease. Radiological methods were used to control the state of the implant (radiography in two projections and CT-scans of the wrist joint). For binary indicators, the number, rates and 95 % confidence interval of frequencies were calculated according to the Wilson formula in the groups. Comparison was carried out by Fisher's exact two-sided test. The p-error was corrected using the Benjamini – Hochberg method. Kaplan – Meier curves were constructed for survival analysis. The groups were compared using a generalized chi-square test.

Results Each case of repeated surgical intervention was evaluated from the standpoint of selected groups. Depending on the time elapsed from surgery to revision, we calculated the time frame for overall and group survival of the components of the wrist joint endoprosthesis. The causes and scope of surgical revision are presented.

Discussion There are no data on the survival of unconstrained ceramic wrist joint implants in the foreign literature. Graphic images according to a proposal for the division of the orthopaedic postoperative period are presented. Conclusions 1. Intermediate conclusions in regard to total arthroplasty with an unconstrained ceramic endoprosthesis of the wrist joint inspire optimism in obtaining a stable positive effect of motion range lost due to the degenerative process in the wrist joint. 2. An 11-year follow-up period demonstrates that the survival rate of an unconstrained ceramic wrist endoprosthesis is 88 %.

Introduction Small joints arthroplasty of the hand including the proximal interphalangeal joint (PIPJ) is associated with the need to create anatomically adapted structures using optimal materials. Introduction of a new medical device requires comprehensive preclinical testing.

The objective was to determine a range of loads allowed for the proximal interphalangeal joint after arthroplasty through analyzing the biomechanics to prevent critical conditions and complications.

Methods A full-ceramic non-constrained anatomically adapted proximal interphalangeal joint implant was developed between 2016 and 2021 using an integrated approach with preclinical trials and a clinical study of 42 patients (25 males, 17 females) with PIPJ arthritis. A digital endoprosthesis was created with 3D-modelling. Critical conditions for the digital model imitating typical joint movements were explored with the use of finite element method and the findings to be employed in clinical practice.

Results A stable biomechanical construct was intact with loads of 5 kilograms and a motion ranging from 0 to 60 degrees, with loads of 20 kilograms and a motion ranging between 0 and 30 degrees. Cortical bone could sustain loads up to 20 kilograms with a motion ranging between 0 and 60 degrees. Discussion Load capacity of the implant was explored considering the strength of bone tissue and zirconium ceramics as a material. The study set a vector for the development of the optimal mode of motor activity early after surgery and indicated the optimal range of motion to be applied after PIPJ arthroplasty.

Conclusion The load up to 5 kg was optimal for the patient to be applied early after surgery with the range of flexion measuring less that 90°. The patient could use a load of 5 to 20 kg with flexion in the proximal interphalangeal joint measuring less than 30°. Endoprosthetic components were likely to get dislocated with a load of 20 kg and flexion angle of greater than 30°. Periprosthetic fracture could occur with flexion angle of greater than 60°.

Introduction Primary total knee arthroplasty has long been proven effective in the treatment of stage 3–4 knee osteoarthritis. It is well known that this intervention not only improves the quality of life, but also helps to restore the function of the joint and eliminate axial deformities.

Purpose To compare early results of total knee arthroplasty using robot-assisted technology with conventional manual technique.

Materials and Methods 20 patients diagnosed with stage 3 osteoarthritis of the knee joint and varus deformity of the knee joint axis were included in a prospective randomized study. Patients were divided into 2 representative groups, 10 subjects underwent robot-assisted knee arthroplasty, and the conventional manual technique was used in the other 10 patients. For clinical assessment, functional scales KSS, WOMAC, Lysholm Score were used, postoperative radiographs were evaluated.

Results According to clinical functional scales, 10 days after surgery, there was an improvement in performance in the patients of both groups (p < 0.05); the duration of the operation in the patients of both groups did not differ in general; intra-operative blood loss in the group with robot‑assisted arthroplasty was lower; and assessment of postoperative results by radiological imaging showed a better component positioning according to preoperative planning in the robotic group.

Discussion When the operation is performed by experienced surgeons, one can expect the correct position of the components and the balance of the ligamentous apparatus in standard arthroplasty. However, the use of robot-assisted technology provides a secure intervention performance even at a hospital where a small number of such operations is performed.

Conclusion Despite the high cost and the need for additional consumables, robot-assisted arthroplasty has a number of advantages over classical manual techniques. These advantages include: accurate restoration of the limb axis even in extra-articular deformities, correct position of the endoprosthesis components, reduction of intraoperative blood loss due to closed medullary canals, and safety for patients. However, the role of the surgeon in such operations remains paramount, as it is the surgeon who is responsible for planning the operation, performing it, and achieving soft tissue balance.

Introduction Hip dysplasia of various genesis is recognized as a common cause of coxarthrosis. Total hip replacement (THR) is the operation of choice for the patients with the final stage of the pathological process. There are different opinions on the impact of previous surgical treatment of hip dysplasia on THR.

The aim of the study was to explore the effects of previous surgical treatment on the outcomes of THR in young patients with dysplastic and secondary coxarthrosis.

Material and methods Surgical outcomes of 78 patients (58 females and 20 males; 91 joints) with dysplastic and secondary coxarthrosis (age 14-30 years, average age 24.3 ± 4.3 years) treated witrh THR were retrospectively reviewed. Patients we assigned to two groups. Group I (control) included 27 patients (33 joints) with dysplastic coxarthrosis primarily treated with THR. Group II (treatment group) included 51 patients (58 joints) who had previously undergone THR.

Results Patients of group II demonstrated longer duration of surgery by 47.89 %, greater blood loss by 16.92 % and the higher complication rate by 42.1 %.

Discussion The treatment group showed a significantly increased frequency of late complications in the form of implant instability. Patients of group II dermonstrated better functional results estimated with HHS as compared to the outcomes of patients of group I.

Conclusion Hip reconstructions performed earlier were associated with technical difficulties, aggressive THR procedure, a greater risk of late complications, but showed no significant effect on the outcomes.

The first experience in robotic total knee arthroplasty (RoTKA) has been obtained resulting in the questions about clinical efficiency and accuracy of lower limb alignment.

Objective To clarify clinical evaluation and accuracy of alignment of the mechanical axis of the lower limb in RoTKA.

Materials and methods Twenty-nine patients with osteoarthritis of the knee of Kellgren-Lawrence stage 3-4 underwent RoTKA. The knee joint was assessed with VAS, WOMAC, FJS-12; the range of motion was measured. The changes in the axis of the lower limb were evaluated on the full limb length radiographs.

Results Pain before the surgery according to VAS was 5.8 ± 1.5 points, on the first day after the surgery it was 8.5 ± 1.4, on day 3 – 5.9 ± 1.2, on day 12 – 2.9 ± 1.1. The range of motion on the first day after the surgery was 99.5° ± 1.4°, three months later – 115.1° ± 1.1°, six months later – 125.6 ± 1.5°, one year later– 127.5 ± 1.6°. The WOMAC score before the surgery was 32.7 ± 3.3, after the surgery 25.1 ± 2.1, three months later 7.3 ± 1.3, six months later 2.8 ± 0.2, and after one year – 1.3 ± 0.5. The FJS-12 score 3 months after the surgery was 68.2 ± 4.1, after 6 months 80.3 ± 2.9, after one year 94.0 ± 2.1. The analysis of postoperative full length roentgenograms in 72 % of cases (n = 21) did not reveal any deviation of the mechanical axis from the planned one and in 28 % of cases (n = 8) the deviation of the mechanical axis was up to 1° from the planned one.

Discussion Neither technical difficulties nor complications inherent to RoTKA were found. According to the results of VAS, WOMAC and FJS‑12 questionnaires, and the assessment of the range of motion, a positive dynamics was observed. According to the results of tele-roentgenograms, there was alignment of the limb axis and the accuracy of the position of the endoprosthesis components.

Conclusion The study of this technology has demonstrated safety, accuracy of alignment of the mechanical axis, validity of indications and contraindications, and stable early clinical results.

Introduction The problem a large number of revision operations due to aseptic loosening after primary hip arthroplasty necessitates the search for a new material for a friction pair. The pyrocarbon, which has high tribological characteristics, can be used both in a monolithic and in a prefabricated design; however, the manufacture of a monolithic pyrocarbon block complicates production.

Aim Compare the strength characteristics of the stem head and liner designs with monolithic and non-monolithic pyrocarbon.

Materials and methods To assess the reliability of the designs, a digital mathematical model of the head and liner implants with a monolithic and non-monolithic pyrocarbon component was built. After the manufacture of prototypes friction pairs, an assessment of the static load on bench tests was carried out.

Results While analyzing the mathematical model, the construct of non‑monolithic pyrocarbon broke in one of the experiments, while the strength of the construct of monolithic pyrocarbon was 4.5 times higher than the stresses arising under load. While studying the maximum static load, the friction pair from monolithic pyrocarbon exceeded the maximum possible load in the human hip joint by 5 times.

Discussion The studies allow us to be confident about the reliability of the design in in vitro studies, which will create conditions for reducing the number of revision surgeries after hip arthroplasty.

Conclusion Based on the data obtained, the design of the head and liner of the hip joint endoprosthesis with a friction pair made of carbon material will provide high reliability under conditions of functioning in the hip joint at maximum loads. It serves as a prerequisite for conducting a clinical study of the proposed friction pair.

Introduction Proximal femur fractures can be associated with nailing and total hip arthroplasty (THA). Treatment of elderly inpatients necessitates adequate postoperative pain relief. Obese patients require specific inpatient and outpatient treatments.

The objective was to evaluate the effectiveness of pain relief in obese patients at the stages of rehabilitation after primary THA performed for a proximal femur fracture.

Material and methods VAS score was compared in two groups of 60 clinical cases to evaluate the effectiveness of postoperative multimodal pain relief using the author's method.

Results Comparable results of an effective and stable pain relief were obtained in the two groups by the time the patient was discharged from the hospital 5-6 days after THA. Multimodal analgesia with a glucocorticosteroid injected in the projection of the sacroiliac joint provided an effect being greater by 29 % than with use of opioids after two postoperative days and by 11 % after five postoperative days.

Discussion Old age, comorbidities are associated with optimal surgical strategy. THA in patients with extra-articular proximal femur fractures can improve the rehabilitation potential early after surgery and general clinical and functional results providing high quality of life in the late rehabilitation period.

Conclusion THA demonstrated a stable positive effect of pain relief in the study group of patients with proximal femur fractures, regardless of the weight and the height. Positive dynamics in pain relief was seen in patients with elevated BMI of any gradation, including those with BMI ≥ 40.

Introduction A variety of surgical techniques used to treat a closed sciatic nerve injury after total hip replacement (THR) require careful evaluation and comparison of short- and long-term outcomes of the complex management emphasizing a paucity of publications on the subject and a high social and economic role of the issue.

The aim of the study was to compare outcomes of various surgical techniques used to treat closed sciatic nerve injuries afterTHR.

Material and methods A total of 94 patients with closed sciatic nerves injuries associated with THR were divided into three groups. Microsurgical neurolysis of the sciatic nerve was produced for patients of Group I; patients of group II underwent microsurgical neurolysis of the sciatic nerve and electrical nerve stimulation; patients of group III had microsurgical neurolysis and electrical stimulation of the sciatic nerve with multichannel electrodes and segmental apparatus of the spinal cord at the conus and epiconus level. Clinical and neurological tests, dynamic electrophysiological monitoring were employed for clinical and functional evaluation.

Results In In the postoperative period, positive dynamics in clinical and electrophysiological parameters with improved pain, lower limb functionality, increased amplitudes and decreased latency of M‑response with most positive changes observed in Group III compared to Group I and Group II (p < 0.05).

Discussion The function of the sciatic nerve restored in all patients with the most pronounced effect recorded in group III. The effect from the technique was associated with a simultaneous electrical stimulation of the trunk of the peripheral nerve and the segmental apparatus of the spinal cord causing synergetic effect on the structures.

Conclusion The most effective method of surgical treatment was the use of Microsurgical neurolysis combined with two-level electrical stimulation was shown to be most effective and characterized by faster pain regression and positive dynamics in clinical and electrophysiological parameters in the affected lower limb of patients Group III.

Analysis of clinical and laboratory tests is essential for monitoring the course of infectious complications after total hip arthroplasty (THA).

The objective was to assess the reliability of differences in hematological parameters in patients with periprosthetic joint infection (PJI) for monitoring the infectious process.

Material and methods Patients with acute (lasting 21.8 days on average) and chronic (lasting for 26.3 months on average) PJI were screened for hematological parameters on admission and during treatment in order to control the course of the purulent-inflammatory process.

Results Preoperative parameters demonstrated mild anemia in patients with acute PJI, and the hemoglobin concentration was normal in patients with chronic PJI. Patients of both groups showed normal total leukocyte count. ESR and C-reactive protein levels were many times higher than the threshold values. The C-reactive protein level was more than 2 times higher in patients with acute PJI than that in patients with a chronic infection. The ratio of ESR / C-reactive protein was normally greater than 5 units, from 3 to 4.5 in chronic PJI and from 1.5 to 2.3 in acute PJI. Discussion Examination of pre- and postoperative clinically significant parameters is practical for identification of the criteria to assess the risk of chronic PJI.

Conclusion Patients with acute PJI need no additional clinical and laboratory examination, integral laboratory parameters can be employed for accurate assessment of the extent of inflammation in a purulent wound.

Introduction Timely diagnosis, etiopathogenesis, treatment and prevention of the progression of pediatric flexible pes planovalgus (FPPV) are essential to prevent irreversible complications.

The objective was to determine a correlation between whole-blood serotonin level and flexible pes planovalgus in children and adolescents over a period of four years with progression of the condition.

Material and methods The whole-blood serotonin level was measured in children and adolescents aged 5-15 years with FPPV and compared with data from photoplantograms, a pronation angle of the calcaneus and radiographs of the feet. Based on serotonin measurements and photoplantograms, two groups were identified according to the course of flexible pes planovalgus and measurements during the next four years.

Results Normal serotonin levels were maintained in the non-progressive FPPV group throughout the study with a 9.2 % decrease in the pronation of the calcaneus at 4 years. Progressive FPPV patients showed higher serum serotonin at one year with a 38.3 % increase at 4 years, increased pronation of the calcaneus by 21.2% and radiologically decreased height of the arch by 18.7 %. A moderate correlation between whole-blood serotonin levels, pronation of the calcaneus and the height of the foot arch was radiologically revealed in patients with a different course of FPPV. Analysis of the diagnostic effectiveness of the whole-blood serotonin test in patients with FPPV showed high sensitivity and specificity in predicting the risk of progression of FPPV.

Discussion Literature review showed a paucity of research on clinical and laboratory detection of the progression of FPPV and examination of neurotransmitter mechanisms in the foot pathology. Plantography, 3D scanning and radiography were the main methods for the diagnosis of the flat feet.

Conclusion The correlation between whole-blood serotonin level and flexible pes planovalgus in children and adolescents was identified and suggested involvement of the serotoninergic system in the formation and progression of foot pathology.

Introduction It has been shown that titanium implants with a structured surface provide an increased rate of osseointegration what makes their application quite promising.

The purpose of this work was to conduct a comparative evaluation of the efficiency of osseointegration of new percutaneous implants for prosthetics made of ultrafine-grained Ti Grade 4 alloy.

Materials and methods The study was carried out on 12 male rabbits of the Soviet Chinchilla breed. Six rabbits of the control group had implants made of Ti6Al4V powder using selective laser sintering technology that were osseointegrated into the tibia, 6 rabbits of the experimental group had implants made of Ti Grade 4 by equal channel angular pressing. The formation of the "bone-implant" block was examined 26 weeks after the implantation.

Results Histologically, after 26 weeks of the experiment, porous changes, enlargement of the Haversian canals, and pronounced osteoclastic resorption were not detected in the animals of the experimental group throughout the stump in the compact plate. Around the implant, a bony case repeating the bone shape was formed, represented by lamellar bone tissue. Using X-ray electron probe microanalysis, it was found that in the substrate formed on the surface of the implant in rabbits of the experimental group, there was significantly more calcium in all areas over the implant relative to the animals of the control group. In the control group, relative to the experimental group, an increased level of C-reactive protein in blood serum was retained longer. Complications and significant clinical and laboratory abnormalities were not found in both groups during the entire experiment.

Discussion Our data are consistent with the results of other experimental studies, which unambiguously noted that titanium implants with a structured surface show increased osseointegration characteristics in comparative studies relative to implants without modification of the structure of the material of the threaded surface. The absence of complications and undesirable reactions of the animal organism also indicates the acceptable safety of the tested products.

Conclusion Osseointegration of a percutaneous implant that has a mixed nanocrystalline and ultrafine-grained structure was more effective than the reference implant. This makes the use of such implant promising for solving clinical problems in prosthetics.

Introduction Polymethyl methacrylate (PMMA) is a common depot system in the treatment of chronic osteomyelitis. However, a lot of its shortcomings do not allow us to consider it ideal.

Purpose of the work was to study in vivo the effectiveness of a polymer hydrogel containing an antibiotic for chronic osteomyelitis of the tibia in a rabbit model and compare it with PMMA.

Materials and methods The study was performed on the lower leg of 25 mature Chinchilla rabbits. A model of chronic osteomyelitis of the tibia was created. A methicillin-sensitive strain of Staphylococcus aureus (MSSA), highly active against cefazolin, was chosen as an infectious agent. Surgical debridement started 21 days after the clinical, laboratory, radiological and microbiological confirmation of the diagnosis, the technique for all animals was the same. The experimental group (n = 11) was treated by implantation of a polymer hydrogel, the comparison group (n = 11) with PMMA, and the control group (n = 3) had no implanted substance. In the postoperative period, monitoring of the local status, weight and body temperature of the animals, microbiological and radiological studies were carried out. Animals were taken out of the experiment by stages. Biopsies were sent for bacteriological and histomorphometric studies. Statistical comparison of the groups was performed using the Mann ‑ Whitney, Kruskell ‑ Wallis and Tukey criteria, descriptive statistics were used for the control group.

Results In the experimental group, in all cases, postoperative wounds healed in a timely manner, the levels of WBC and CRP significantly (p = 0.040) decreased from 14 and 21 days, respectively. Microbiologically, the growth of microflora from the wound discharge and biopsy specimens was not detected; radiographic progression of chronic osteomyelitis was not observed; histomorphometry revealed a significant (p = 0.002) effective relief of the inflammatory process. In the comparison group, systemic antibiotic therapy was required from postoperative day 7. Levels of inflammatory markers decreased less effectively than in the experimental group. MSSA was verified from wound discharge and biopsy specimens at almost every follow-up time-point. X-rays and histomorphometry (p = 0.001), on average, detected exacerbation of osteomyelitis. In the control group, systemic therapy did not give positive dynamics.

Discussion A comparative analysis showed that the hydrogel impregnated with an antibacterial agent, unlike PMMA, reliably arrests chronic osteomyelitis without auxiliary systemic antibiotic therapy and does not cause material-associated bone resorption. The clinical and laboratory picture is fully consistent with the data of microbiology, radiology and histomorphometry.

Conclusion Hydrogel impregnated with an antibiotic reliably and effectively stops chronic osteomyelitis compared to PMMA.

Introduction Replacement of extensive Paprosky type IIIB and type IV bone loss is a challenge in revision total hip arthroplasty (THA).

The purpose was to demonstrate the possibility of femoral reconstruction in proximal femur bone loss using a custom-made implant for revision THA.

Material and methods We report a case of a 72-year-old patient with an extensive Paprosky type IV femoral defect, which was replaced using a custom-made modular component.

Results The femoral defect was successfully augmented with a custom-made modular component, and the hip function was restored. The locking mechanism of the constrained system failed at 6 months with the joint remained stable. The patient could ambulate with additional support. VAS, HHS and HOOS scores measured before and after 2 years showed positive dynamics.

Discussion Paprosky type IIIB and type IV defects are a challenge for revision hip arthroplasty. There is a variety of surgical options with outcomes being ambiguous. Modular and monoblock tapered stems, the technique of impacted bone graft have been reported to have excellent results in revision THA with Paprosky type III and IV defects. A custom-made femoral component was developed based on the principle of modular stems. Joint stability is a concomitant problem with a severe bone defect that can be addressed with a double mobility or constrained system. Both methods are associated with a sufficient number of complications.

Conclusion Replacement of a Paprosky type IV femoral defect with a custom-made modular component demonstrated satisfactory outcomes at a two‑year follow-up. The patient had no complaints, could ambulate unassisted using an elbow crutch and positively evaluated the result of treatment.

Background Fixation of pathological long bones with telescopic intramedullary rods is well known to be a technically challenging procedure even in specialist centres, with a high complication rate due to rod migration, hardware failure, nonunion or malunion. However there is very little guidance in the literature regarding salvage treatment options when failure occurs.

Aim We demonstrate a surgical technique that can be used for salvage treatment of both femoral and humeral complex nonunions following Fassier-Duval (FD) rodding in a child with osteogenesis imperfecta (OI).

Case description A 13 year-old girl with OI type VIII presented sequentially with nonunion and deformity of the femur then the humerus following previous FD rods in those segments. The femur was also complicated with metallosis between the steel rod and an overlying titanium plate. Both segments were treated with pseudarthrosis debridement, removal of metalwork and stabilisation with hydroxyapatite (HA)-coated flexible intramedullary nails, with temporary Ilizarov frame to provide enough longitudinal and rotational stability to allow immediate weight-bearing. The femur Ilizarov frame was removed after 64 days, and the femur remained straight and fully healed at 2.5 years. The frame time for the humerus was 40 days, complete union was achieved and upper limb function restored and maintained at 9 months.

Discussion The transphyseal telescopic rod is the traditional implant of choice in terms of treating fractures and stabilising osteotomies for deformity in OI. However, it does not provide enough torsional or longitudinal stability by itself to allow early weight-bearing which is detrimental to bone healing in this vulnerable patient group. The incidence of delayed union or nonunion at osteotomy site in telescopic rod application is not negligible: up to 14.5-51.5 %. Although the technique we have shown in this case may not be applied to all complex OI patients, we believe that the combination of flexible intramedullary nails and Ilizarov frame provides a favourable environment for bone healing in complex or revision cases. As a secondary learning point the initial revision surgery to the left femur demonstrated the perils of using a steel rod and a titanium plate in a biologically active environment which in this case lead to metallosis and lysis.

Conclusion We found the technique of HA-coated flexible intramedullary nails combined with the Ilizarov frame effective in the salvage of failed telescopic rods in both femur and humerus and feel this technique can be used as a salvage option in similar cases worldwide. This case also demonstrates the perils of using different metals in combined internal fixation.

Introduction Mycobacterium abscessus species belongs to the group of non-tuberculosis mycobacteria responsible for chronic infections in people with weakened immunity. M. abscessus exist in various ecological niches and are able to colonize artificial surfaces, including medical and surgical instruments/ devices. Due tothe low incidence of M. abscessus as a causative agent of orthopedic infection, a rare clinical case of periprosthetic infection caused by M.abscessus would interest practitioners.

The aim is to present a clinical case of periprosthetic infection caused by M. abscessus.

Materials and methods From the medical records and discharge documents, it was known that female patient X. underwent total hip replacement at her residence hospital. Signs of acute infection of the postoperative wound appeared in the early postoperative period.

Results Three months later, the patient was hospitalized in a specialized institution with a diagnosis of chronic deep periprosthetic infection. During the examination, the mycobacterial etiology of the process was established. During two hospitalizations, the patient underwent 4 consecutive revision surgeries (including muscle plastic surgery and installation of an antimicrobial spacer) and massive parenteral antibiotic therapy for 8 months, including at the outpatient stage, using at least 3 antibacterial agents. After 4 years, the patient does not complain of the infectious process. Postoperative scar is 45 cm. The residual shortening of the right lower limb of 3 cm was compensated by orthopedic shoes.

Discussion Treatment of infection caused by M. abscessus is challenging due to the natural resistance of the pathogen to a wide range of antibacterial drugs. The literature describes separate cases of orthopedic infections caused by this pathogen. All authors agree that the key to successful treatment is a combination of radical surgical debridement and antibacterial therapy using at least three antimicrobial drugs.

Conclusion A rare clinical case of periprosthetic infection caused by Mycobacterium abscessus after primary hip replacement is presented. This infectious agent is a rare pathogen, for which there is no proven therapeutic algorithm. Long-term aggressive antibiotic therapy in combination with stage-by-stage surgical treatment was successful.

Introduction Ceramic hip replacement bearings have shown to be low wearing and biocompatible. The last two generations of Biolox Forte and Biolox Delta ceramics have have established themselves as durable bearings. However, squeaking and noise from ceramic bearing THRs is well recognised in the 21st century.

The objective was to explore the problem of noise in the ceramic bearing of THA based on the analysis of the foreign and Russian literature.

Material and methods In presented the analysis of Foreign and Russian literature searches for the review were produced according to PRISMA recommendations using PubMed, Scopus, Google Scholar, eLibrary. MINOR was used to assess the methodological quality of articles.

Results and Discussion Noise in ceramics is observed in 37.7 %. There are many theories on the origin and mechanism of noise including liner impingement and loading, film disruption, third body, microseparation and resonance. However, there is still no consensus on what is noise in the ceramic bearing and how to solve this problem.

Conclusion Literature review of ceramic bearing indicated enough unanswered questions. The noise may play a role as a predictor of improper use of endoprosthesis with accumulated database resulting in better understanding of the phenomenon, methods of the correction and timely prevention of ceramic breakage.