Introduction One of the underestimated causes of pain in the heel area is neuropathy of the medial calcaneal nerve, which can both imitate and accompany plantar fasciitis. Some researchers note that neuropathy of the medial calcaneal branch of the tibial nerve is the cause of pain syndrome localized in the heel area. Knowledge of the main landmarks and anatomical variability of the medial calcaneal nerve passage in the foot can facilitate anesthesia, surgical interventions, including hydrodissection.

Purpose To determine the anatomical variability of the medial calcaneal nerve, including the level of  its  origin,  transverse diameter and topographic location relative to the main anatomical landmarks of  the  medial calcaneal area in order to use the obtained data in foot surgery, regional anesthesia and differential diagnosis of pain syndrome localized in the calcaneal area.

Materials and methods Dissection of the medial heel region was performed in 16 cadavers (32 feet). For each specimen, we measured the thickness of the tibial and medial calcaneal nerves, as well as the distance (centimeters) from the tip of the medial malleolus to the point where the medial calcaneal nerve branched off from the tibial nerve, and to the bifurcation point of the tibial nerve into the medial and lateral plantar nerves.

Results The study found that the medial calcaneal nerve branched from the tibial nerve at a distance of 2.7 ± 0.7 cm distal to the tip of the medial malleolus. The cross-sectional diameter of the nerve varied and averaged 1.9 ± 1.2 cm. In 15.6 % of cases, the medial calcaneal nerve had an additional branch. In the vast majority of cases (72 %), it terminated within the subcutaneous fat of the medial aspect of the calcaneous.

Discussion The findings confirmed considerable anatomical variability of the medial calcaneal nerve. In 15.6 % of cases, it originated from the lateral plantar branch, which is consistent with the findings of other researchers. The morphological features of branching in the tibial nerve and its distal segments are of particular importance in foot surgery. Unintentional nerve injury is possible during interventions in the region of the tarsal tunnel (including radiofrequency denervation or endoscopic release).

Conclusion This cadaveric study confirmed marked anatomical variability of the medial calcaneal nerve. These findings expand our understanding of the variable anatomy of the heel area and may aid in interpreting clinical cases of pain caused by compression or trauma to the medial calcaneal nerve, as well as in performing regional anesthesia.

Introduction Proximal humerus fractures account for 5 % of all fractures. Their incidence increases with age, especially in women over 60. Most of them (85 %) are minimally displaced and managed non-operatively, while 15 % require surgery. Neer’s classification guides treatment, which includes conservative methods and operative methods. The operative techniques are PHILOS plating, pinning, nailing, or arthroplasty. The JESS fixator, developed by Dr. B.B. Joshi, offers a minimally invasive alternative.

Purpose To compare the functional results of proximal humerus fractures treated with PHILOS plating and JESS fixation.

Material and method The prospective observational study was conducted over 24 months on 36 patients with proximal humerus fractures. Patients were divided into two groups, 18 in each group, based on the surgical technique used: JESS fixation and PHILLOS plating. JESS group had more females, while PHILOS had more males. The Constant – Murley Scores were used to compare the functional outcome in both groups at regular intervals. Complications of both techniques were assessed.

Results Falls were the main cause in JESS (72.22 %), while road accidents were more common in PHILOS (55.55 %) group. Both groups showed significant improvement in Constant – Murley Scores (p < 0.005). JESS group had one case each of avascular necrosis, malunion, and pin tract infection. PHILOS group had one implant failure and one avascular necrosis case, both managed effectively.

Conclusion In the management of proximal humerus fractures, JESS fixation and PHILOS plating are equally effective. This study also led us to the conclusion that JESS fixation for proximal humerus fractures is a semi‑rigid, inexpensive technique that permits early mobilization, needs few implants, requires a short hospital stay and surgical period, resulting in good to excellent functional results with a minimal risk of complications.

Introduction The anterior cruciate ligament (ACL) is the main ligament that stabilizes the knee and stops anterior translation. It is also essential to the screw-home mechanism and helps resist valgus and rotational stress. For ACL reconstruction, autograft arthroscopic single-bundle surgery is regarded as the "gold standard" procedure. Joint laxity is enhanced and cartilage degradation is avoided with anatomical ACL restoration. Negative results are frequently caused by technical surgical errors, such as improper tunnel placement.

This study aims to evaluate the functional outcome in ACL-reconstructed patients when a graft is placed in an anatomical position, as well as to compare it with when a graft is placed in a non-anatomical place.

Methodology This is a 24-month prospective observational study conducted on 44 patients who underwent arthroscopic ACL reconstruction, with post-op CT scans performed after permission from the institutional review board (IRB). The most common mode of injury was sports-related. Thirty patients belonged to the  anatomical group, and 14 patients belonged to the non-anatomical group based on inclusion and exclusion criteria. The Lysholm scoring system was used for functional evaluation on follow-up at three, six, and 12 months.

Results The mean Lysholm score was 41.24 before surgery for the entire sample. In the anatomical group, the score improved to 80.91 at three months, 85.91 at six months, and 89.23 at twelve months. In the non‑anatomical group, the score was 58.58 at three months, 65.13 at six months, and 58.58 at twelve months. The improvement in Lysholm scores in the anatomical group was statistically significant.

Conclusion This study concludes that the functional outcome of ACL reconstruction is better when the graft is placed in anatomical footprints than when it is placed in non-anatomical footprints.

Introduction Periprosthetic infection (PJI) after total knee arthroplasty remains a serious challenge for  orthopedic surgeons and requires radical treatment methods. Femoro-tibial synostosis (FTS) is one of  the  last salvage operations if revision arthroplasty fails or impossible. However, there is currently no  consensus on a rational technology that would provide an optimal anatomical and functional result of surgical rehabilitation.

The aim of the work was to analyze clinical outcomes of surgical treatment performing FTS of the knee joint in the patients with PPI using an intramedullary nail (IN) versus the Ilizarov apparatus (IA).

Materials and methods A comparative analysis of 46 patients with PPI who underwent arthrodesis of  the  knee  joint (AKJ) was performed. The patients were divided into two groups depending on the osteosynthesis technology for bone fusion between the femur and tibia: 25 patients in group 1 (IN) and  21 in  group  2  (IA). The  clinical characteristics of the patients, comorbid background, type of bone defects and microbiological profile were assessed. Statistical analysis of the comparison of functional results, timing of ankylosis, limb shortening, recurrent infections and complications was performed using the Jamovi software (version 2.6.17).

Results The average time of bone fusion was significantly shorter in group 1 (IN), 4.5 months versus seven  months in group 2 (IA), p = 0.027. Functional results of the groups were comparable (p = 0.075). In  defects  with  significant bone loss (AORI type III), patients in group 2  (AI) demonstrated better LEFS indicators (p = 0.018). The infection recurrence rate was 13 % in group 1  (IN) and 4.8 % in  group 2  (IA), p = 0.609. Systemic complications (6.5 %) were detected only in group 1 (IN). Adverse events were considered using the unified classification of complications.

Discussion The obtained results indicate that IN and IA provide comparable treatment efficacy in patients with PPI with differences in the timing of bone fusion and functional indicators in significant bone defects. The increasing prevalence of multiresistant microflora and the frequency of complications require a careful and individual approach to the choice of the FTS technique.

Conclusion The results of the study demonstrate the effectiveness of both techniques: the use of IN contributes to a more rapid bone fusion between the femur and tibia, while IA provides better anatomical and functional results in patients with significant bone loss.

Introduction Treatment of patients with orthopedic infection includes a combination of the optimal surgical debridement and  adequate antibacterial therapy. Gram-negative bacteria are encountered in 13–28 % of orthopedic infections, and A. baumannii, K. pneumoniae, P. aeruginosa are significant bacteria notorious for its high and intrinsic antibiotic resistance and can be associated with worse outcomes.

The objective was to substantiate the choice of drug for targeted empirical and etiotropic antibacterial therapy based on the analysis of antibiotic resistance in leading gram-negative bacteria (A. baumannii, K. pneumoniae, P. aeruginosa) isolated from patients with orthopedic infection.

Material and methods Antibiotic sensitivity of leading Gram(–) microorganisms isolated from patients with  orthopedic infection was retrospectively examined between 01.01.2011 and 31.12.2022. The average frequency of isolated resistant strains was examined and resistance trends of leading Gram(–) pathogens to various antimicrobialbacterial drugs (fluoroquinolones, co-trimoxazole, cephalosporins, carbapenems, monobactams, aminoglycosides, fosfomycin, colistin) determined.

Results Over a 12-year period, statistically significant trends were revealed towards an increase in the proportion of A. baumannii strains resistant to ciprofloxacin (p = 0.024) and levofloxacin (p = 0.012), and P. aeruginosa (p = 0.018) and K. pneumoniae (p = 0.018) strains resistant to ciprofloxacin. The predicted proportion of A. baumannii strains resistant to fluoroquinolones tends to 100 %. There was a significant increase in A. baumannii and P. aeruginosa strains resistant to cefoperazone+[sulbactam] (p = 0.027 and p = 0.010, respectively), K. pneumoniae strains resistant to meropenem and imipenem (p = 0.037 and p = 0.003, respectively), and P. aeruginosa strains resistant to imipenem (p = 0.001). No statistically significant trends were found for the remaining antibiotics; drug resistance of the pathogens remained stable or had a wave-like course over the 12-year period. Cefoperazone + [sulbactam] was the optimal drug active against Gram(–) bacteria.

Discussion There is an authoritative list of antimicrobiall drugs active against A. baumannii, K. pneumoniae, P. aeruginosa strains, mainly containing drugs for parenteral administration. The list is limited to one or two groups for resistant strains, and there are no drugs available in oral form. This causes difficulties in the infection control and a high rate of relapses. The negative dynamics in increasing antibiotic resistance of leading Gram(–) pathogens to fluoroquinolones, cephalosporins and carbapenems is a global problem necessitating the use of reserve antibiotics.

Conclusion Protected cephalosporin is more practical for targeted empirical initial antimicrobial therapy due to the lower risk of selected resistant strains. Fluoroquinolones and carbapenems can be used with the sensitivity known. Polymyxin B and fosfomycin should be considered as reserve drugs for the treatment of infections caused by strains resistant to other AB, and prescribed as part of combination therapy. Aminoglycosides and unprotected cephalosporins can be an alternative due to the pharmacokinetic characteristics and high level of resistance when more active drugs cannot be administered.characteristics and high level of resistance when more active drugs cannot be administered.

Introduction The optimal age for performing multilevel interventions in patients with cerebral palsy is the  period from 10 to 16 years, but indications for eliminating contractures, torsional bone deformities, and foot deformities in children with cerebral palsy of GMFCS level I–III may also occur at an earlier age.

The aim of the work is to evaluate changes in the kinematic and kinetic parameters of gait in children with spastic diplegia who underwent multilevel bilateral surgical interventions for orthopedic complications of cerebral palsy that arose before the onset of pubertal growth acceleration.

Material and Methods 63 children with cerebral palsy, I–III GMFCS. Group 1 (n = 50): average age 7.1 years, no orthopedic interventions had been performed previously. Group 2 (n = 513): average age 7.4 years, isolated interventions were performed at the age of up to 4 years.

Results In group 1: after the operation for two years — an increase in the strength of all extensor muscles with a reliable difference compared to the preoperative level; after 4–5 years — stabilization of the achieved improvements in kinematics. In group 2: after the operation for two years — a decrease in the values of the total working power of the lower limb muscles; after 4 years — decompensation of motor capabilities occurred, the working power of the muscles of the hip and ankle joints did not exceed the initial values, and for the knee joint, the decrease in working power was permanent.

Discussion The positive effect of surgical intervention in both groups is similar and consists of improving the synergistic interaction of muscles.

Conclusion Orthopedic multilevel surgeries performed in children for orthopedic complications before prepubertal growth spurt are associated with functional development only in children who did not undergo early Achilles tendon lengthening or percutaneous fibromyotomies. The result remains stable for 4–5 years after surgery. Isolated Achilles tendon lengthening or percutaneous fibrotomies prevent lower limb muscular development in the long-term follow-up period.

Introduction Gait analysis is an objective tool for assessing treatment results and musculoskeletal function in patients with orthopedic pathology. Safety of compensatory mechanisms and the fatigue component seen with repeated measurements and being dependent on the clinical situation are essential for the patients.

The objective was to develop a methodology of gait assessment for identifying mechanisms of decompensatory musculoskeletal fatigue in patients with hip arthritis including those with THA of the contralateral limb.

Material and methods The study included 41 patients with Kellgren – Lawrence grade III and  IV  hips. Gait  analysis was performed using the Stedis-Step treadmill and five Neurosens inertial sensors (Neurosoft LLC, Ivanovo, Russia), recording the spatiotemporal and kinematic characteristics of movements in  the  lumbosacral  spine, hip and knee joints being synchronized with the step cycle. Patients were divided into two groups according to gait assessment protocol including Group 1 (n = 26) with three series of two‑minute tests with a break of at least 20 minutes; Group 2 (n = 15) with three series of two-minute walks without a break with the total length of six minutes.

Results A 20-minute rest was enough to reproduce baseline gait parameters. Walking parameters including maximum flexion phase, stance period and range of motion could serve as markers for early detection of  mechanisms of decompensatory muscle fatigue. The total hip arthroplasty on the contralateral side significantly affected the gait parameters.

Discussion New methods of no-break gait assessment facilitated decompensation and fatigue mechanisms identified in patients with hip arthritis. Reduced movement amplitude during short-term load indicated increasing fatigue even over a brief period (6 minutes).

Conclusion The methodology allowed for the identification of mechanisms of decompensatory musculoskeletal fatigue in patients with hip arthritis including those with THA of the contralateral limb, early diagnosis, improved monitoring and rehabilitation.

Background Sclerostin is a glycoprotein mostly produced by osteocytes; it has a key function in bone metabolism and the pathophysiology of osteoporosis.

Objectives The aim of this study is to evaluate the potential use of sclerostin as a new biomarker in the diagnosis of osteoporosis.

Methods This case-control cross-sectional study was carried in Najaf, in Iraq. Seventy patients diagnosed with osteoporosis were involved in the study. The control group consisted of 40 apparently healthy persons identified during the same period. Body Mass Index (BMI) categories were classified according to the world health organization classification. Serum sclerostin levels were determined by a sandwich ELISA technique.

Results The mean sclerostin concentration in patients was 7.9 ± 2.3 ng/mL, much greater than that measured in the control group 2.88 ± 1.22 ng/mL. The univariate logistic regression analysis shows a significant association between high sclerostin levels and the likelihood of having osteoporosis, with an odds ratio of  1.66  and  a  p-value of < 0.034. The results also indicated that sclerostin reported a sensitivity of 78 % and specificity of 82 % (p-value 0.029).

Conclusions This study indicated a strong association between high serum sclerostin levels and having osteoporosis risk, suggesting its potential as a bone health biomarker. Further research on larger sample is required to confirm its diagnostic value.

Background Neurofibromatosis type 1 (NF-1) is a hereditary tumor syndrome characterized by cutaneous, subcutaneous and plexiform neurofibromas, optic nerve gliomas, cognitive disorders and can be associated with orthopedic pathology. Clinical manifestations of NF-1 include skeletal abnormalities requiring a specific approach to treatment of the tumor-like processes in the involved bones and joints.

The objective was to determine the frequency of orthopedic pathology and clinical manifestations of the disease in NF-1 patients seen in the Republic of Bashkortostan (RB) and make international comparisons.

Material and methods Outpatient records of patients with a clinical diagnosis of NF-I, the results of laboratory and  instrumentation studies were examined. A retrospective analysis of the frequency of  occurrence of the main clinical manifestations of NF-1 and orthopedic pathology was conducted. An interactive 2 × 2 contingency table was used for calculation of association statistics (Pearson χ² criterion) with the Yates correction for continuity developed by V.P. Leonov and four-field contingency tables were analyzed.

Results and discussion The incidence rate of NF-1 was 1:7407 by 2024 in the RB, which is 2.3 times less than the world average (1:3000 people). Associated malformations included scoliosis seen in 17.4 %, chest deformity observed in 5.3 %, pseudoarthrosis in 3 %, facial dysmorphism in 9 %, short stature in 13.8 % of patients. Osteoporosis, facial asymmetry and sphenoid wing dysplasia were not observed in NF-1 patients in the region. A statistically significant difference in the frequency of occurrence of orthopedic pathology was determined in patients with NF-1 from the RB using four-field contingency tables. A retrospective analysis showed a statistically lower incidence of orthopedic pathology in NF-1 patients of RB as compared to the world average which indicated the need to include orthopedic consultation in medical and economic standards for the timely detection of pathology and treatment.

Conclusion Analysis of orthopedic pathology in NF-1 patients from RB showed the occurrence of  chest deformity, scoliosis, short stature and pseudoarthrosis being comparable with world data. Skeletal anomalies, facial dysmorphism and macrocephaly were not common for NF-1 patients of RB. No cases of osteoporosis, facial  asymmetry and sphenoid wing dysplasia being characteristic of NF-1 patients were detected in  the  patients. Learning difficulties were more common for NF-1 patients with orthopedic pathology as compared to NF-1 patients of RB.

Introduction Noise from a total hip replacement's ceramic friction pair is known as hip squeaking. Acoustic arthrometry in total hip replacement (THR) involves using acoustic emission technology to visualize sound characteristics.

The objective was to identify the possibility of identifying noises of a THR ceramic friction pair using the acoustic arthrometry and to determine the relationship of noises with the position of the acetabular component.

Material and methods The retrospective study included 36 patients who underwent THR with a ceramic bearing pair. Seven patients (19.44 %) reported noise at the site of the THR joint. The patients were divided into two groups based on the noise (n = 7) and no noise reported (n = 29). Clinical and radiological parameters were reviewed through online survey considering age, follow-up period, BMI, inclination and anteversion of  the  acetabular component. Acoustic arthrometry was performed for 10 patients with the pulse height, PEAK, ASYMMETRY and WIDTH measured and compared.

Results Comparative analysis of individual clinical and radiological parameters showed no statistically significant differences in the two groups. However, deviations by any of the two criteria in the acetabular component position was 20.7 % in the no-noise group and 57.1 % in the noise reported group (p = 0.048). Acoustic emission of THR with noise had visual differences in acoustic signature with the mean PEAK measuring 0.492 in the no-noise group and 0.488 in the noise reported group; ASYMMETRY being 0.012 versus 0.015 and WIDTH measuring 479.2 versus 486.5, respectively. Discussion The findings correlated with the results of previous studies and confirmed the relationship between the angles of the implanted acetabular component and the noise. In contrast to previous studies of  acoustic arthrometry, the method offered facilitated objective statistical noise assessment in addition to visualization and analysis of acoustic signatures.

Conclusion The study demonstrated possibilities of acoustic arthrometry in identification of different states of the ceramic friction pair, characterization of the noise detected and its quantification.

Introduction Knee joint infection (septic arthritis) is a rare but severe postoperative complication. With  the  increasing number of primary and revision arthroscopic surgeries on large joints performed annually, the incidence of infectious complications has also grown.

The aim of this study is to present the outcome of a successful two-stage treatment of a female patient with  knee joint infection caused by methicillin-resistant Staphylococcus epidermidis after arthroscopic anterior cruciate ligament reconstruction.

Materials and Methods A 22-year-old female patient diagnosed with chronic posttraumatic osteomyelitis of the right femur and tibia, arthritis of the right knee following reconstruction of the anterior cruciate ligament (ACL) of the right knee. Her medical records stated several failures of debridement surgeries. The first stage involved joint debridement, removal of the infected ACL graft, and filling of the bone defects with bone cement containing antibacterial agents. In the second stage, the bone cement was removed, the bone defects were filled with allograft bone chips, and ACL reconstruction was performed using the peroneus longus tendon. Clinical, instrumental, and functional evaluations of treatment effectiveness were performed.

Results The treatment managed to control the infection. Remission of the infection was achieved, and function of the affected limb was restored. The follow-up period was two years.

Discussion There are few publications in the Russian medical literature on the treatment of infection after  arthroscopic surgery on large joints. This clinical case demonstrates a positive outcome in infection resolution after ACL reconstruction with forced ligament removal following failures of debridement procedures.

Conclusion The choice of treatment strategy was based on the patient's medical history and desired needs. The management of knee infection that developed after ACL reconstruction included appropriately selected and administered antibiotic therapy and the necessary number of timely surgical interventions. This optimally chosen approach ultimately resulted in good outcome.

Introduction Ankylosing spondylitis (AS) is a chronic inflammatory disease with associated rigid spinal deformities and sagittal imbalance. The identity of the clinical case reported was characterized by AS combined with Andersson lesion, pronounced three-plane deformity and the need for multi-stage combined surgical treatment involving an original technique of external reduction.

The objective was to demonstrate surgical treatment of a patient with severe spinal deformities due to ankylosing spondylitis complicated by Andersson lesion and severe sagittal imbalance.

Material and methods The clinical case of a 53-year-old patient with severe kyphoscoliosis, chronic pain and horizontal gaze disorder is reported. Multicomponent surgical management included a Schwab type 6 osteotomy at the Th₁₂–L₁ level, spondylodesis via posterior and transpleural approaches, osteoplasty of post‑screw defects, placement of laminar hooks and reconstruction of the metal construct. Preoperative 3D planning and original methods of fixation and reduction of the spine were employed.

Results With the implant instability developed after the primary operation, successive staged surgical interventions facilitated restoration of the axis and support of the spinal column. Reliable interbody spondylodesis with no signs of hardware instability and improvement in the patient's quality of life were observed at one-year follow-up.

Conclusion The clinical case demonstrated the need for a comprehensive multi-stage approach to the treatment of an AS patient with severe spinal deformities complicated by Andersen lesion and severe sagittal imbalance. The staged treatment resulted in sustainable clinical and functional improvement with the emphasis on individualized planning and adapted surgical strategy if complications arise.

Introduction Current therapy for managing achilles tendon rupture are classified into surgical and conservative method. Randomized controlled trials were performed in multiple healthcare facilities in multiple centers across the world yet functional outcomes, re-rupture rate and complications are still indecisive.

The aim of this study is to compare surgical versus conservative methods for the treatment of acute Achilles tendon rupture; including functional outcome, re-rupture rate, and complications to provide better guidance in selecting therapeutic method.

Materials and Methods We conducted a comprehensive electronic database. Original articles until November 2023 were screened, focusing on randomized controlled trials with at least 12 months follow up. Our protocol has been registered at PROSPERO ID (CRD42023486152).

Results and Discussion The initial search yielded 354 studies. Twelve randomized controlled trials study with a  total of 1525 participants were assessed. Surgical treatment has better outcomes for preventing: re‑rupture (p ≤ 0.001), abnormal ankle movement (p ≤ 0.001), and calf muscle atrophy (p = 0.005). Functional outcomes at 6 months follow-up were better for hopping (p ≤ 0.001), heel-rise height (p ≤ 0.001), and heel‑rise work (p = 0.007) in surgical treatment. Functional outcomes at 12 months of follow-up were better only for heel‑rise work test (p ≤ 0.001) in surgical treatment. However, incidence of sural nerve injury (p = 0.006) was found lower in the conservative group. Complications other than re-rupture (p = 0.08) had no significant difference between two groups. At 6-month follow-up, functional outcome tends to be better compared to conservative management of Achilles tendon rupture. At 12-month follow-up, functional outcomes was comparable between two groups. However, the risk of re- rupture rate is higher in the conservative management.

Conclusion Reduced rates of re-rupture and quicker functional recovery are benefits of surgical repair. Conservative treatment can yield good results in terms of functional outcomes and re-rupture rates in  long‑term follow up, particularly when combined with contemporary rehabilitation procedures. Conservative treatment eliminates the hazards associated with surgery, but it may have a slightly higher chance of re‑rupture and a shorter initial recovery of some functional outcomes. Both of these treatment methods are good for treating Achilles tendon rupture.

Level of Evidence: I.

Introduction Periprosthetic infection is one of the most frequent and devastating complications after total hip replacement. The effectiveness of infection management depends on possibility of prescribing etiotropic antibiotics after the operation and the rational choice of a surgical technique. In 5–30 % of all patients the etiology of the infectious process remains unknown throughout the entire treatment period. Such cases are described by the term "culture-negative periprosthetic joint infection". Nowaday, there is no single definition for culture-negative PJI in the professional community.

The aim of this study is to evaluate the treatment results of patients with culture-negative periprosthetic infection, depending on the approach to its detection, as well as formulate possible ways to reduce its rates.

Methods Literature search was performed in electronic databases eLIBRARY, PubMed (MEDLINE), ScienceDirect, Google Scholar according to PRISMA recommendations. The study included articles in Russian and English, original articles and case series on the treatment of chronic culture-negative periprosthetic infection of the hip joint and/or knee joints in patients over 18 years of age using any surgical operations and in which there was at least one indicator of treatment effectiveness. The existing approaches to detection of culture-negative periprosthetic joint infection of the knee and hip and the outcomes of treatment of patients with this pathology were analyzed, as well as possible ways to reduce the number of patients with an unknown etiology of the infectious process were formulated.

Results and Discussion Our analysis of scientific publications revealed no clear difference in the effectiveness of  infection control depending on the approach to detection of culture-negative PJI. For the first time, the effectiveness of treatment for patients with culture-negative PJI is examined depending on the  approach to detection of this pathology. Significant heterogeneity was identified in both the interpretation of culture‑negative PJI and the choice of surgical techniques. The high rate of successful outcomes indicates the importance of appropriate selection of drugs for empirical antibiotic therapy (ABT) and regular monitoring of the spectrum of nosocomial pathogens. Potential ways to reduce the incidence of negative microbiological test results are proposed.

Conclusion The efficacy of treatment of culture-negative PJI did not differ significantly depending on the interpretation of this term. Ways to reduce the incidence of this pathology are aimed at modifying the factors that cause negative results of MBI of biomaterial samples and removed structures.