Introduction Total hip arthroplasty (THA) is an effective treatment for end-stage hip joint involvement in patients with rheumatoid arthritis (RA), reducing pain and improving function. However, systemic inflammation, secondary osteoporosis, and the specific nature of antirheumatic therapy can complicate surgical treatment of the patients. Understanding the interrelationships between standard therapy options is crucial for optimizing perioperative management and improving clinical outcomes of THA.

The objective was to evaluate the impact of different variants of disease-modifying anti-rheumatic therapy on postoperative outcomes of THA patients with rheumatoid arthritis.

Material and methods A review of 314 clinical cases of primary THA was performed. The study included patients with RA (n = 194) and involutional arthrosis (IA) (n = 120). The parameters assessed included radiographic changes (Kellgren-Lawrence and Paprosky classifications, cortical index), surgical treatment, intraoperative blood loss, surgical outcomes, complication rate, pain dynamics evaluated with VAS, joint function assessed with the Harris Hip Score, RA severity assessment using the DAS28, and the quality of life (QoL) using the HAQ questionnaire.

Results RA patients were characterized by more pronounced acetabular defects and a reduced cortical index compared to IA patients (p < 0.0001). The use of disease-modifying antirheumatic drugs was associated with better bone structure preservation, while long-term glucocorticosteroid therapy was associated with worsening radiographic parameters and greater blood loss. Intraoperative blood loss was higher in RA with the use of glucocorticosteroids and nonsteroidal anti-inflammatory drugs. Both groups showed improved clinical outcomes, decreased pain, and improved joint function at three months of THA; however, IA patients achieved more significant results.

Discussion The findings suggested the key role of systemic inflammation and the nature of antirheumatic therapy in determining surgical risks and functional outcomes of endovascular knee replacement. The type of antirheumatic therapy effecting intraoperative features of endovascular knee replacement and surgical outcomes were also highlighted.

Conclusion THA is a surgical treatment modality that can improve clinical, functional outcomes and quality of life of RA patients. Long-term steroid therapy has a detrimental effect on bone tissue, complicating the surgery and increasing intraoperative blood loss.

Introduction Total hip arthroplasty (THA) is highly effective for advanced hip disease, and modern research increasingly compares surgical approaches to optimise recovery and outcomes. The direct anterior approach (DAA) offers muscle-sparing benefits and faster early recovery but is technically demanding with a steeper learning curve. The posterior approach (PA) remains widely used due to familiarity but may carry a higher risk of dislocation. This study prospectively compares outcomes of DAA and PA over one year, evaluating operative time, pain, function, radiographic accuracy, and complications.

The purpose was to determine whether the early recovery advantages reported with DAA persist over one year follow-up and how these benefits compare with the increased technical demands and potential risks associated with the approach.

Materials and Methods This single-centre prospective study (Jan 2024–Jun 2025) compared outcomes of 36 primary THA patients treated with the direct anterior (DAA) or posterior approach (PA). One surgical team performed all procedures using standardised perioperative care. Patients were followed for one year. The assessed parameters were pain (VAS), function (HHS), radiographic accuracy, and complications using blinded evaluation and appropriate statistical analysis.

Results A total of 36 THA patients were enrolled (18 in DAA group and 18 in PA group) with comparable baseline demographics. Operative time was longer in the DAA group, but hospital stay, postoperative pain progression, functional recovery, and radiographic outcomes were similar. Two intraoperative fractures occurred in the PA group and one early infection in the DAA group, all successfully managed. Overall, both approaches showed equivalent one-year outcomes with low complication rates.

Discussion This study compared functional outcomes between the PA approach and DAA approach in hip THR. Both approaches sgowed comparable one-year outcomes; DAA offered earlier recovery but longer operative time, with similar complication rates.

Conclusion Despite longer DAA operative times, both approaches showed similar one-year outcomes, emphasizing that surgeon’s skill and patient selection matter more than approach choice.

Introduction Femorotibial synostosis (FTS) is a primary salvage surgical procedure for failed total knee arthroplasty complicated by periprosthetic joint infection (PJI). Despite its widespread use, clinical outcomes with FTS are highly variable, indicating the significant role of a combination of patient-related, infectious, and surgical factors in shaping treatment outcomes. Analysis of the factors that lead to failed synostosis outcomes is of practical interest for optimizing surgical treatment techniques and predicting outcomes.

The purpose of the study was to evaluate factors associated with an FTS adverse course and outcomes as an option for restoring limb weight-bearing ability in patients with PJI.

Materials and methods A retrospective study included 46 patients who underwent FTS for PJI. The influence of patient-related (gender, age, body mass index, comorbidities), infectious (PJI type according to D.T. Tsukayama, microbiological profile), and surgical factors (number of previous debridement surgeries, anatomical and functional features of bone defects according to AORI, fixation method) associated with poor outcomes was analyzed. Univariate binary logistic regression analysis was used with calculation of odds ratio (OR) and 95 % confidence interval (95 % CI). The prognostic significance of the model was assessed using discriminant analysis.

Results Adverse FTS outcomes were statistically significantly associated with rheumatoid arthritis (OR = 6.89; 95 % CI 3.78–12.35; p = 0.002), immunodeficiency states (OR = 2.7; 95 % CI 0.44–8.24; p = 0.02) and the predominance of gram-negative microflora (OR = 7.1; 95 % CI 1.23–35.77; p = 0.028). Large bone defects (AORI type III) and five or more debridement surgeries had a significant impact on functional results and residual limb shortening. The use of an intramedullary nail for fixation correlated with an increased risk of systemic complications (OR = 6.69; 95 % CI 1.33–9.9; p = 0.035) and severe functional limitations (OR = 10.67; 95 % CI 1.201–15.72; p = 0.034). A direct relationship was established between the number of risk factors and the probability of adverse outcome (p < 0.001). The constructed prognostic model had sensitivity (77.8 %) and specificity (85.7 %).

Discussion The findings obtained indicate the heterogeneous nature of adverse FTS outcomes. The cumulative effect of individual factors, rather than their isolated presence, is important. This nature of the relationships explains the high variability of clinical outcomes, creating the need for an integrated risk assessment and the development of a surgical treatment algorithm for patients.

Conclusion Adverse FTS outcomes in PJI results from the combined impact of patient-related, infectious, and surgical factors. The most significant factors are the patient's comorbidity, the microbiological profile of the infection, the complexity of the anatomical and functional changes in the limb due to bone defects, and the chosen fixation method. A comprehensive assessment of risk factors allows for more accurate prediction of treatment outcomes.

Introduction. There is currently no consensus on the effectiveness of the Ilizarovor Masquelet technologies, and their combination in long bone defect management. The greatest challenge is restorative treatment for patients with bone defects accompanied by purulent infection, both during remission and exacerbation of the inflammatory process.

The aim of the work is a comparative analysis of the effectiveness of the combined use of the Ilizarov non-free bone grafting and the Masquelet technique versus the classical Ilizarov bone transport in patients with bone defects of the tibia in the conditions of active purulent infection and its remission.

Materials and Methods. This study is based on the analysis of the results of a multicenter study of the restorative treatment of 56 patients who underwent a combination of the Ilizarov non-free bone grafting and the Masquelet technique for tibia defects in the presence of osteomyelitis remission (Group 1, n = 33) and active infection (Group 2, n = 10), as well as the classical Ilizarov bone transport technique in the presence of active infection (Group 3, n = 13).

Results. The conditions for bone transport predetermined different durations of the transosseous osteosynthesis stages for filling similar-sized defects in the tibia. In Groups 1 and 2 (combined technology), the duration of the osteosynthesis stages was quite comparable. In the patients of Group 1, the transport of the fragments continued for (62.4 ± 10.4) days, the fixation stage was (163.4 ± 5.6) days. The duration of distraction in patients of Group 2 was (63.9 ± 15.2) days, the fixation period was (150.5 ± 19.4) days. Surgical rehabilitation of the patients in Group 3 took a longer time: distraction was performed for (115.3 ± 37.5) days, and additional (331.9 ± 122.9) days were required for restoration of the bone skeleton of the tibia. In two patients in Group 1 (7.4 %) and two individuals in Group 2 (20 %), wounds healed by secondary intention, with fistula formation. A recurrence of purulent infection was noted within one year after dismantling of the fixator and removal of the transosseous fixation elements, requiring minor surgical debridement and antibacterial therapy. Complete suppression and eradication of purulent infection was not achieved in one patient in Group 2. No recurrence of purulent infection was observed in Group 3 patients during follow-up.

Discussion. The combination of the Masquelet technique and Ilizarov non-free bone grafting, despite the implantation of spacers with a prophylactic dose of antibiotics and empirical antibacterial therapy, does not guarantee the elimination of the risk of purulent recurrence if debridement of infected areas is not complete. However, combining the Masquelet technique and Ilizarov non-free bone grafting, the formation of an induced membrane creates favorable conditions for Ilizarov bone transport during the second stage of surgical treatment.

Conclusion A comparative analysis of surgical rehabilitation of patients using the Ilizarov non-free bone grafting and the combined use of Ilizarov bone transport and the Masquelet technique in patients with bone defects of the tibia with active purulent infection and its remission showed that the treatment period in the classical Ilizarov bone transport method was longer, but it did not result in recurrence of the purulent process. Guaranteed arrest of purulent infection is only possible after radical surgical debridement and debridement of the purulent bone wound.

Introduction Rotational alignment of the femoral component is important for a good functional outcome and the long-term success of total knee arthroplasty (TKA).

The objective was to evaluate the effectiveness of a customized approach for accurate rotational positioning of the femoral component in total knee arthroplasty.

Material and methods Outcomes of TKA were comprehensively evaluated in 94 patients with Kellgren – Lawrence grade III–IV osteoarthritis. Femoral component rotation was determined in the first group (n = 46) using visual-manual techniques based on the posterior condylar and surgical supracondylar lines. A goniometer was used in the second group (n = 48) to determine the surgical supracondylar line along the anterior tangent line at the angle measured with computed tomography. Statistical analysis of the data was performed using IBM SPSS 20 Statistics and Statistica 13.3 software packages.

Results Analysis of postoperative data on the angle between the surgical supracondylar and posterior condylar lines in the first group revealed a deviation from the normal values with a median of 3.45° (1.9°; 3.8°), indicating significant external rotation of the femoral component. Internal rotation of the femoral component of the implant was observed in two clinical cases reaching 3.5°, indicating mild to moderate malrotation. The anterior tangent line served as a landmark in the second group, and the mean arithmetic value of the angle between the surgical supracondylar and posterior condylar lines measured 0.9° (0.6°; 1.2°) postoperatively. The measurement suggested the significant line to be used as a promising landmark in primary TKA.

Discussion Ji et al. explored the angle between the surgical supracondylar and anterior tangent lines and performed a comparative analysis of methods based on supracondylar, anterior tangent, and anterior patellar lines. The approach facilitated an objective assessment of the applicability for solving clinical problems and confirmed our analytical data. The authors emphasized the anterior patellar line and suggested its potential for correcting varus deformity of the knee joint. In our series, the knee alignment was not considered and the focus was on the anterior tangent line, which has not been reported in Russian studies.

Conclusion The customized approach for accurate rotational positioning of the femoral component using the FAT line demonstrated its high efficacy in TKA. The approach facilitated accurate component positioning minimizing the risk of errors. The findings suggested that customized navigation techniques can be used in routine clinical practice.

Introduction Knee osteoarthritis (OA) represents a significant challenge in modern orthopedics and can be associated with short-term and long-term disability. Medial knee OA correlates with medial meniscus extrusion, leading to rapid progression of OA.

The objective was to compare surgical outcomes of patients with medial knee OA treated with original and standard methods.

Material and methods Treatment outcomes of 80 patients (44.5 [43.0; 47.0] years) with grade 2 medial knee OA due to medial meniscus damage are reported. The patients were surgically treated using arthroscopic partial meniscus resection (Group 1; n = 20); arthroscopic meniscus centralization (Group 2; n = 20); arthroscopic partial meniscus resection combined with fibular osteotomy (Group 3; n = 20); original technique of arthroscopic meniscus centralization and proximal fibular osteotomy (Group 4; n = 20). Patients were examined preoperatively, at three, six and 12 months of surgery using WOMAC, Lysholm and KOOS grading systems, radiology and MR imaging. The nature of meniscal injury and the extent of meniscal extrusion were evaluated using the WORMS method. Statistical processing of the results was performed using the IBM SPSS Statistics Version 25.0 software package.

Results There were statistically significant differences in the WOMAC, Lysholm, and KOOS scores (p < 0.05) in patients of group 4 and groups 1–3 at 12 months. Statistically significant differences were seen in the WOMAC and Lysholm scores (p > 0.05) in patients of group 3 and group 1 and in Lysholm scores of group 2 (p < 0.05). Statistical differences were recorded in the width of the joint space in the medial knee joint of patients of groups 1, 2 and groups 3, 4, while no differences were found between groups 3 and 4 for this parameter, p > 0.05.

Discussion The effectiveness of the original technique could be caused by the synergistic effect of the two components. Realignment and restored function of the meniscus facilitated normal load distribution, and proximal fibular osteotomy ensured decompression of the medial compartment and the limb realignment with improved function and objective radiographic changes.

Conclusion The original surgical method offered for the treatment of the medial knee OA demonstrated superior results compared to the standard approaches facilitating lasting pain relief, restored knee function and improved quality of life for patients.

Introduction Mechanical isolation of the stromal vascular fraction (SVF) from autologous adipose tissue represents a promising approach in regenerative treatment of osteochondral defects of the knee joint. However, intra-articular SVF administration may be associated with a post-injection synovial reaction, which decreases the tolerability of the procedure and complicates early clinical assessment. Therefore, optimization of the cell preparation protocol aimed at improving biological purity and reducing reactive intra-articular changes remains clinically relevant.

Purpose To evaluate the impact of a modified mechanical SVF isolation protocol combined with highly concentrated platelet-rich plasma (P-PRP) on the severity and duration of post-injection synovial reaction in patients with osteochondral knee defects.

Materials and Methods A retrospective-and-prospective comparative non-randomized study included 62 patients. Group I consisted of 41 patients treated using the standard mechanical SVF protocol. Group II included 21 patients treated with a modified protocol incorporating liposaspirate washing, mechanical emulsification through a 0.6 mm filter, and P-PRP preparation using double centrifugation with ACD-A anticoagulant. Comparative analysis was performed based on the severity and duration of post-injection synovial reaction using clinical and instrumental stratification and ultrasound assessment.

Results In the standard protocol group, mild synovial reaction was observed in 4 (9.8 %) patients, moderate in 16 (39.0 %), and severe in 21 (51.2 %). In the modified protocol group, mild reaction was recorded in 11 (52.4 %) patients, moderate in 7 (33.3 %), and severe in 3 (14.3 %). The median duration of synovial reaction was 11 (9–12) days in the standard protocol and 5 (3–7) days in the modified protocol (p < 0.001).

Discussion The addition of liposaspirate washing and mechanical purification through a 0.6 mm filter in the protocol, along with double centrifugation using ACD-A, reduced the final injection volume and increased platelet concentration in PRP (> 1 × 10⁶/µL), which was associated with decreased severity and shorter duration of synovial reaction.

Conclusion The modified mechanical SVF isolation protocol improves early post-injection tolerability by reducing the severity and duration of post-injection synovial reaction. The proposed technique is reproducible and may represent a promising approach for optimizing regenerative therapy in patients with osteochondral knee defects.

Introduction Poor outcomes in the treatment of fracture-dislocations of the talus lead to revision surgeries and disability. A standardized algorithm for minimally invasive reduction is absent.

Purpose Analysis of treatment outcomes in patients with fracture-dislocations of the talus using the developed minimally invasive reduction.

Materials and Methods Data from 46 patients were analyzed. Group A (n = 21) underwent algorithmic reduction, while Group B (n = 25) served as controls. The groups were matched by sex, age, and injury severity. Medical records, CT scans, radiographs, SF-36, and Foot and Ankle Outcome Score (FAOS) questionnaires were assessed and evaluated.

Results In Group A, reduction followed a stepwise approach: Type 1 injuries received instrumental and manual reduction; complex types 2–3 were converted to type 1; multifragmentary fractures (type 4) underwent open reduction. The Ilizarov fixator with ankle hinges was used in Group A. Minimally invasive reduction success rate was three times higher in Group A: 13 cases (62 %) versus 5 (20 %) in Group B. Avascular necrosis occurred in 1 patient (5 %) in Group A versus 9 (36 %) in Group B, 7.2 times less. SF-36 and FAOS scores were significantly higher in Group A. Joint arthrodesis was required 6.7 times more frequently in Group B.

Discussion We achieved low rates of aseptic necrosis and the need for subsequent arthrodesis, as well as good evaluation grading results for minimally invasive reduction techniques in Group A, which is consistent with the authors' opinions using hardware-based reduction and osteosynthesis techniques. A differentiated approach to reduction and patient management depending on the type of talar fracture-dislocation is a distinctive feature of the proposed algorithm.

Conclusions The minimally invasive reduction algorithm is reproducible and triples success rate. The algorithm reduces the complication rate of avascular necrosis and infection rate. The algorithm technique results were superior in functional outcomes (SF-36, FAOS) and therefore reduced arthrodesis necessity. The hinged Ilizarov fixator is crucial for preventing talar collapse and arthritis.

Introduction Post-traumatic osteoarthritis of the ankle and subtalar joints develops secondary to joint trauma, with clinical signs of pain and dysfunction of the lower limbs in working age patients. Tibiotalocalcaneal arthrodesis (TTCA) is the standard surgical treatment for end-stage disease. The optimal fixation method remains a matter of debate.

The objective was to compare clinical and functional outcomes of TTCA for end-stage post-traumatic osteoarthritis of the ankle and subtalar joints using three methods of internal fixation.

Material and methods A retrospective controlled parallel-group study enrolled 46 patients treated with TTCA and anatomically curved retrograde intramedullary nail (Group 1, n = 15); TTCA using a straight retrograde intramedullary nail (Group 2, n = 15); arthrodesis and interlocking nailing (Group 3, n = 16). Clinical status and functionality were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Visual Analogue Scale (VAS). Statistical analysis was produced using Kruskal – Wallis test, Mann – Whitney U-test with Bonferroni correction, Pearson χ² test, Fisher's exact test (p < 0.05).

Results Groups were comparable for age and VAS pain intensity at baseline (p = 0.162 and p = 0.268, respectively). Baseline AOFAS differed significantly (p = 0.049) with the median measuring 20.0 (15.0–32.5) in Group 1, 32.0 (27.5–40.0) in Group 2, and 29.5 (26.0–37.2) in Group 3. The AOFAS functional scores were comparable at a follow-up examination measuring 73.0 (52.5–79.0), 71.0 (66.5–78.0), and 75.0 (50.8–80.0) in the groups, respectively (p = 0.978). Pain reduction was equivalent across groups (p = 0.661). Complications developed in seven cases (15.2 %) with no significant between groups differences (p = 0.354); active smoking was a significant predictor of complications (31.2 % vs 6.7 %; p = 0.040). Patient satisfaction was 100%, 93.3 %, and 75.0% in groups 1, 2 and 3, respectively (p = 0.067).

Discussion Comparable outcomes across three groups were consistent with the literature: the success of arthrodesis rather relies on adequate foot positioning and the quality of joint resection rather than on a fixation construct.

Conclusion The three internal fixation options for TTCA provided comparable clinical and functional results in the mid-term follow-up period. Individual patient characteristics and surgical experience would be essential for the choice of the construct.

Introduction Surgical treatment of the forefoot deformities using corrective osteotomies can be associated with local reactions, manifested by postoperative swelling and pain. The factors can impact the timing and quality of early patient rehabilitation. The search for safe and effective means to relieve postoperative swelling and pain is essential in modern traumatology and orthopedics. The escin lysinate solution with angioprotective, anti-edematous, and analgesic effects, is considered as a pathogenetically substantiated approach.

The objective was to compare the efficacy and safety of escin lysinate used to reduce postoperative swelling and pain in patients after corrective osteotomies of the foot and the standard therapy and therapy supplemented with a short course of systemic glucocorticosteroids.

Material and methods A prospective randomized study included 30 patients (18–70 years) who underwent SCARF osteotomy of the first metatarsal bone, AKIN osteotomy, and/or Weil osteotomy. Patients were divided into three groups (10 individuals each) who underwent standard therapy (control); standard therapy + escin lysinate; standard therapy + dexamethasone. The severity of swelling of the limb, pain assessed with the visual analog scale (VAS), the need for nonsteroidal anti-inflammatory drugs (NSAIDs), the level of C-reactive protein, and the safety of therapy were dynamically evaluated.

Results The pain significantly reduced in the first three postoperative days in the escin lysinate group as compared to the control group with a reduced need for NSAIDs. A greater edema regression was observed at the metatarsal level at six weeks. Dynamics in pain was noted in the dexamethasone group at a short term with a less need for NSAIDs. No adverse reactions or clinically significant changes in laboratory parameters were recorded.

Discussion Postoperative edema was more evident in the foot as compared to other anatomical sites due to limited soft tissue volume and slow venous and lymphatic outflow from the distal extremities. In this context, medications that reduce vascular and tissue permeability play a role. Aescin lysinate was shown to demonstrate efficacy in neurosurgery and otolaryngology with the use being associated with reduceed edema and inflammation. In orthopedics and traumatology, the drug demonstrated angioprotective and analgesic potential in lower extremity injuries. Unlike systemic glucocorticosteroids such as dexamethasone having a pronounced but short-term anti-inflammatory effect and being associated with the risk of hyperglycemia, infections and bone loss, escin lysinate has a safety profile and can be considered as a pathogenetically justified agent for the control of postoperative inflammation and edema.

Conclusion A comparative evaluation of the adjuvant use of escin lysinate, standard therapy, and therapy supplemented with a short course of systemic glucocorticosteroids after corrective foot osteotomies demonstrated earlier pain relief and accelerated edema resolution with no risk of adverse reactions with escin lysinate. The drug can be considered an effective and safe addition to standard therapy, providing a more favorable early postoperative effect.

Materials and methods Biofilms of S. aureus bacteria were grown in 96-well plates and on coverslips for 24 hours. Twenty-four hour old biofilms were treated with disinfectants according to the developed protocol. The effect of antiseptics and disinfectants on monospecies biofilms of S. aureus was assessed visually and quantitatively on glass coverslips using an Axio Lab. A1 microscope (Carl Zeiss, Germany) and an ELx808 photometer (BioTek, USA) at a wavelength of 630 nm. All experiments were repeated four times.

Results Disks impregnated with 3 % Н₂О₂ or 6 % H₂O₂ skin antiseptics had a bactericidal effect against all clinical isolates studied. S. aureus strains formed biofilms with varying intensity on the surface of coverslips and in 96-well plates. Impregnation with 3 % or 6 % hydrogen peroxide decreased the intensity of MSSA biofilm formation by 1.2 times compared to control values and of MRSA by 1.5 times. The application of a skin antiseptic to 24-hour old biofilms did not lead to a significant decrease in the level of biofilm formation. Biofilms in the groups differed in structure and morphology.

Discussion The varying activity of disinfectants against monospecies biofilms depends on their type and concentration. Low concentrations of H₂O₂ disrupt cell membranes, oxidize DNA, and destabilize enzymes and proteins. Sublethal concentrations of H₂O₂ can lead to the emergence of cells with the small colony variant (SCV) phenotype due to increased mutation rates and subsequent replication, which will facilitate the survival of the pathogen in body tissues.

Conclusion Hydrogen peroxide at a concentration of 3 % and 6 % suppresses the activity of biofilm formation by clinical strains of S. aureus and MRSA, but does not completely remove them from the abiotic surface, which indicates the bacteriostatic nature of the action of the disinfectant. The skin antiseptic is not effective against the biofilm form of bacteria, but can have a bactericidal effect on single adhered cells around which the exopolysaccharide matrix has not formed yet.

Introduction Long-term clinical outcomes can be optimized based on degeneration mechanisms of microstructural changes in the supporting elements of the spine and an objective assessment of the severity of pathological changes and the extent of surgical intervention.

The objective was to explore the relationship between preoperative age, behavioral, physiological, professional characteristics of patients, morphological and radiological parameters of the lumbar segments and long-term surgical outcomes of railway workers with degenerative diseases of the spine treated with lumbar total disc arthroplasty (LTDA) and transforaminal lumbar interbody fusion (TLIF) to objectify indications for the use.

Material and methods Surgical outcomes of 223 railway workers with single-segment lumbar degenerative disease treated with LTDA (n = 64) and TLIF (n = 159) between 2015 and 2018 were retrospectively reviewed. Univariate logistic regression analysis was used to identify and evaluate the influence of various risk factors on poor clinical outcomes.

Results A long-term poor outcome of lumbar LTDA was associated with age > 40 years, body mass index > 28 kg/m², smoking, posterior osteophytes, dynamic sagittal angle over 10°, decreased interbody height of > ½ of the overlying one, Pfirrmann disc degeneration greater than stage III, A. Fujiwara facet joint osteoarthritis greater than stage II, the apparent diffusion coefficient (ADC) less than 1200 mm²/sec, facet angle > 60°, tropism of the facet joint, cellular density of the nucleus pulposus < 1500 cells/mm³, collagen types X and XI. For TLIF, the factors included body mass index over 28 kg/m², smoking, category III energy expenditure at work, dynamic linear translation < 4 mm, facet angle < 60°.

Discussion The findings suggested systematization of patients considering the severity of preoperative degenerative changes in the lumbar segments providing an optimal choice of surgical strategy and prediction of the postoperative follow-up.

Conclusion A unified choice of surgical technology, a comprehensive analysis of preoperative age, behavioral (smoking), physiological (BMI), professional (level of energy expenditure) parameters, morphological and radiological characterization of the lumbar segments were essential for effective treatment of clinical symptoms in the late postoperative period in railway workers with single-level degenerative disease of the lumbar segments.

Introduction The search for the optimal method of external osteosynthesis for proximal femoral fractures without  pelvic  fixation  has  once  again  become  relevant.  This  is  due  to  casualties  with  gunshot  fractures of this location, accompanied by extensive soft tissue defects, referred to military medical organizations.

Purpose  To  develop  a  method  for  stabilizing  bone  fragments  using  the  Ilizarov  apparatus  through biomechanical modeling of various external osteosynthesis options for proximal femoral gunshot fractures, ensuring gradual hip joint movement and weight-bearing on the involved limb.

Materials and Methods Based on computer tomography data, a biomechanical model of a proximal femoral fracture and its osteosynthesis methods using various fixation devices were constructed. Stresses and strains arising from typical loads experienced by the injured during controlled weight-bearing on the operated lower limb were studied. In bench tests on specially prepared models, the elastic strength of the Ilizarov apparatus models was investigated, and the maximum mechanical loads that the studied fixators can withstand were identified and analyzed.

Results  The  use  of  the  Ilizarov  apparatus,  ensurig  stabilization  of  the  proximal  fragment  with  a  bundle of polyaxially inserted tensioned 3-mm wires and its additional fixation with support rods, provides the most favorable stress-strain parameters in the "bone-fixator" system compared to an unreinforced Ilizarov apparatus configuration.  The  results  of  the  finite  element  modeling  were  confirmed  with  bench  tests.  Comparison of  the  results  of  biomechanical  modeling  of  external  osteosynthesis  variants  with  the  Ilizarov  apparatus and internal osteosynthesis with a proximal femoral nail indicates the advantages of internal fixation.

Discussion The obtained data are in full agreement with the results of biomechanical studies that presented the results of biomechanical modeling of osteosynthesis options for tibial fractures. According to these authors, in the "bone–locked nail" system, the mechanical stress in the fixator is lower than in the "bone–external fixator" system. Moreover, prolonged stress concentration on the elements of the fixation device can cause their weakness. However, the inability to use internal osteosynthesis techniques in proximal femoral gunshot fractures justifies the development and clinical application of the proposed Ilizarov apparatus configuration, which stress-strain parameters are the closest to the proximal femoral nail.

Conclusion The data obtained substantiate the possibility of using the developed external osteosynthesis method with the Ilizarov apparatus in clinical practice for treating gunshot fractures. The results of the experimental study prove the prospect of using the proposed Ilizarov apparatus configuration for long-term stabilization of this type of fracture under the conditions of graded weight-bearing on the involved limb and hip joint movement throughout the entire consolidation period.

Introduction Restricted elbow function following injury and disease results in pathophysiological changes in the muscles, tendons, joint capsule, and cartilage. Intra-articular fibrous adhesions and arthrofibrosis with collagen deposition and synovial hypertrophy develop. It aggravates the contracture and complicates treatment.

The purpose of the work was to present a new method of treating patients with elbow joint contractures using hydraulic mobilization that eliminates bone conflict during flexion-extension movements.

Materials and Methods To improve the effectiveness of treatment for patients with flexion and flexionextension contractures of the elbow joint without bony conflicts during articular surface movements, a method of hydraulic mobilization was developed (Invention Application No. 2025131920 dated November 14, 2025). The method includes sequential hydraulic lavage, hydraulic mobilization of the dorsal and ventral sections of the elbow joint, medication administration, and staged plaster casting. This method was used to treat a 63-year-old patient with post-traumatic contracture and osteoarthritis of the right elbow joint. Elbow flexion was 40°, extension 90°. At short- and long-term (one year) follow-ups after surgery, the patient's quality of life significantly improved: self-service was full, pain was absent, and elbow movements were restored.

Discussion Methods for administering fluids under pressure for joint dilation in shoulder and knee pathologies, arthroscopic debridement with continuous passive motion and intra-articular analgesic infusion, and hydraulic lavage of the elbow joint for osteoarthritis are known. However, continuous passive motion can lead to soft tissue trauma and microtears of muscle fibers, resulting in pain and secondary contracture. The developed method has advantages: it allows for the separation of fibrous adhesions thereby the effectiveness of treatment depends on the consistent performance of surgical and postoperative procedures to prevent contracture recurrence

Conclusion The proposed method of hydraulic mobilization for treatment of patients with elbow joint contractures caused by fibrotic changes in the tissues is a low traumatic, minimally invasive surgical intervention that improves the effectiveness of restoring joint function when the indications for its use are met.

Introduction Total knee arthroplasty (TKA) is the gold-standard surgical intervention for end-stage knee osteoarthritis. With the widespread adoption of Enhanced Recovery After Surgery (ERAS) protocols, the selection of an optimal surgical approach has become increasingly relevant to achieving rapid functional recovery.

The aim of this study was to evaluate the efficacy of the subvastus (SV) and midvastus (MV) approaches compared to the medial parapatellar approach (MP) in terms of the rate and ultimate outcomes of functional recovery following TKA.

Materials and Methods This systematic review was conducted in accordance with the PRISMA 2020 guidelines. A literature search was performed across PubMed, Science Direct, Google Scholar, and eLibrary for the period 2020–2025. Eligible studies included original clinical investigations of primary TKA in patients with knee osteoarthritis. Of 607 initially identified publications, 12 studies were included in the final analysis.

Results SV and MV were associated with significantly earlier achievement of active straight leg raise (by 1.3–1.8 days), reduced pain intensity on the VAS during the first 1–3 postoperative days, and greater ROM during the first 3–6 weeks compared with the MP approach (p < 0.05). The rate of intraoperative lateral release was significantly lower in the SV and MV groups. Use of the SV approach was associated with longer operative time by 10–13 minutes. By 3–6 months of follow-up, intergroup differences in KSS, WOMAC, and OKS scores were no longer significant, and at 10–15 years the groups demonstrated full functional equivalence.

Discussion These findings are consistent with the conclusions of major meta-analyses confirming the transient nature of the functional advantages associated with quadriceps-sparing approaches. Heterogeneity in outcomes related to blood loss and length of hospital stay is largely attributable to variability in rehabilitation protocols and discharge criteria across institutions.

Conclusion The choice of surgical approach determines the rate, but not the ultimate outcome, of functional recovery. The SV approach is preferable within ERAS frameworks; however, an individualised strategy accounting for patient-specific anatomy, surgical expertise, and institutional rehabilitation capacity remains the most evidence-based strategy.

The editorial board of the journal Genij Ortopedii congratulates one of the most active proponents and followers of the Ilizarov method, Doctor of Medical Sciences, Professor Dmitry Yuryevich Borzunov, on his 60^th birthday.