Introduction Traumatic lesions of the brachial plexus and analysis of the outcomes of various surgical techniques in patients with this pathology are the relevant challenges in neurosurgery, neurology, traumatology, orthopedics and rehabilitation due to the high social and economic significance, incidence and poor short- and long-term outcomes in this cohort of patients. This study was aimed at comparing the outcomes of various surgical techniques in patients with closed injuries of the brachial plexus.

Material and methods The study involved 96 patients with closed injuries of the brachial plexus divided into three groups according to the method of their surgical treatment. Patients of Group I (n = 33) underwent microsurgical neurolysis of their brachial plexus trunks; patients of Group II (n = 28) had microsurgical neurolysis of their brachial plexus trunks with stimulating multichannel electrodes implanted on the trunks of their brachial plexus; patients of Group III (n = 35) had microsurgical neurolysis with stimulating multichannel electrodes implanted on the trunks of their brachial plexus as well as the segmental spinal cord apparatus at the level of the cervical intumescence. The clinical status and functionality of the upper limb were assessed after 6 months with clinical and neurological tests, scoring methods, and electrophysiological monitoring.

Results We analyzed the outcomes of various surgical techniques in patients with closed injuries of the brachial plexus to prove a significant improvement in the outcomes of Group III patients who featured a faster rate of pain regression in the injured upper limb as well as significantly positive changes in clinical, neurological and electrophysiological indicators.

Discussion The reduction in the total regional pain syndrome and restoration of the affected limb function was more evident in Group III patients what supports the favor of microsurgical neurolysis in combination with two-level electrical stimulation for closed injuries of the brachial plexus.

Conclusions The analysis of various surgical techniques in patients with closed injuries of the brachial plexus revealed a significant efficacy of microsurgical neurolysis in combination with electrostimulation of the injured nerve trunk and segmental spinal cord apparatus (Group III). It improves the outcomes in this cohort of patients.

Introduction Fat embolism syndrome (FES) is a formidable complication that occurs with extremity long-bone fractures. Overall, the mortality of FES is estimated to be 10–36 % depending on the severity of the injury. Early detection of complications, selection of optimal methods for fracture fixation and for anesthesia that would prevent FES are essential.

The objective was to assess the incidence of clinical manifestations of FES in patients with lower extremity long-bone fractures, determine the optimal methods of prevention, methods of anesthesia and surgical intervention in the management of the patients.

Material and methods The study included 355 patients with lower extremity long-bone fractures treated between 2020 and 2021 at the Trauma Department, State Budgetary Healthcare Clinical N.I. Pirogov Hospital No. 1. Patients were grouped according to different parameters including frequency of occurrence of FES depending on the length of the preoperative period: patients with a long and short preoperative period; treatment strategy: patients treated surgically or conservatively; preoperative use of prophylaxis: patients receiving and not receiving "Essentiale"; anesthetic aidused: general or spinal anesthesia.

Results Of the 355 patients examined, FES was detected in 8 patients with fractures of the lower extremities, one patient died. FES developed mainly in the first 72 hours of injury. FES occurred in less than 12 hours (n = 1), in 12-24 hours (n = 2), in 24-48 hours (n = 2), in 48-72 hours (n = 3).

Discussion FES developed in patients with a delayed operative period and in patients treated conservatively. The prophylaxis policy suggests timely diagnosis using Schonfeld's scoring system for FES and taking "Essentiale" early post trauma. Patients who underwent surgery with spinal anesthesia showed a decreased incidence of FES as compared with patients operated on using general anesthesia.

Conclusion There is a high incidence of FES. Hepatoprotectors can be used on the first days after injury to prevent FES. Osteosynthesis under spinal anesthesia is the preferred method of treatment.

Introduction End-stage ankle arthritis is a very painful and disabling pathology, associated with deformity. Infection, poor skin condition, chronic smoking, Charcot arthropathy may not only affect selection of treatment method but also union, leading to unfortunate amputation. Ankle arthrodesis is indicated in advanced ankle arthritis. A variety of fixation methods are available for arthrodesis ranging from internal to external fixation. The Ilizarov ring fixator is a dynamic versatile fixation method. It is a biomechanically stable and minimally invasive method which promotes bone union and has advantage of initiating early weight-bearing and simultaneous deformity correction. We describe our experience in Ilizarov ring fixator application for ankle arthrodesis in 5 patients with severe ankle arthritis and their functional outcome.

Materials and Methods This retrospective study was conducted in 5 ankle arthrodesis cases using the Ilizarov ring fixator application from July 2021 to October 2022 in the department of orthopaedics, Jaipur national university, India. Average age of patient was 52 years (range, 40-65). Among included patients one patient had chronic osteomyelitis of the distal tibia and severe arthrosis of the ankle joint with a non-healing ulcer, two patients had post-traumatic arthrosis following talus and distal tibia plafond fracture, Charcot ankle arthropathy and tuberculosis of the ankle joint was detected in two patients respectively. Postoperative pain relief, deformity correction and radiological union at the fusion site were defined as success.

Results Fusion was achieved in all patients (100%). Early post-operative ambulation and full weight-bearing was initiated in every case. Pin-tract infection was the commonest complication. Shortening due to arthrodesis was less than 2.5 cm so limb lengthening was not done. Frame removal time was 12 to 14 weeks (average time, 13 weeks). Visual analogue scale was used in all cases. It was in the range of 2 to 3 points preoperatively and 7 to 9 post-operatively after arthrodesis. Average follow-up period was 6 months and it is still underway. AOFAS score was used for functional assessment.

Conclusion Ilizarov ring fixator application can be considered as versatile, biomechanically stable, minimally invasive method for ankle arthrodesis in severe ankle arthritis associated with poor soft tissue condition, post- traumatic arthritis, infection, deformity, bone loss, Charcot arthropathy.

Introduction Pseudarthrosis and bone defects are the most common consequence of neurofibromatosis type I in children, a rare hereditary disease. Destruction of bone tissue leads to severe deformities and impaired function of the limbs. Disability in such patients may reach 70 %. Surgical treatment of children with this pathology is long, laborious and multi-stage. Traditional orthopaedic methods for managing bone defects are often ineffective. The development of microsurgical methods enables to perform bone transfer of blood-supplied bone autografts.

Purpose To prove the effectiveness of using microsurgical autologous transfer of the vascularized fibula for plastic surgery of bone defects in children with neurofibromatosis type I.

Materials and methods A retrospective monocenter study included 27 pediatric patients who underwent reconstruction of bone defects with a vascularized fibular autograft from 2011 to 2021. The etiology of the bone defect in all patients was neurofibromatosis type I. A fibula graft was used to reconstruct 8 tibiae and 19 forearms. Bone defects averaged 12 cm. Median follow-up was 60 months.

Results The fibula graft survival rate was 100 %. In 5 cases, nonunion of the proximal part of the fibula and the recipient zone was obtained which required iliac crest grafting. The overall rate of good and excellent results was 74 %. The average time to consolidation was 3 months. Discussion According to the literature, the use of autografting of vascularized bone fragments is a ather limited procedure in children with neurofibromatosis type I as it is associated with an increased risk of complications. Due to the restoration of blood flow in the transferred vascularized autograft, it retains its viability and the possibility of bone tissue remodeling.

Conclusion Microsurgical autologous transfer of a vascularised fragment of the fibula is an effective and at times indispensable method of bone plasty in long bone defects in children with type 1 neurofibromatosis. Bone defects larger than 5 cm are an indication for free autologous transfer of a vascularized fragment of the fibula. This method, used in combination with traditional orthopedic methods for the treatment of children, allows obtaining good anatomical and functional results.

Introduction The purpose of this cross-sectional study was anamnestic evaluation of the treatment performed in patients with GMFCS levels I, II, III spastic cerebral palsy and to assess their motor status, quality of life and anatomical disorders in the lower extremities in the age range from 17 to18.5 years.

Material and methods A cross-sectional study was conducted in patients with spastic types of cerebral palsy at the age of 17-18.5 years. The completeness and consistency of previous treatment (according to medical documentation), motor abilities, quality of life, radiographic anatomy of the lower extremities were studied.

Results We selected 73 patients meeting the inclusion criteria out of 201 cases. Insufficient systematic implementation of complex therapeutic measures was revealed, which was reflected in a high rate of orthopedic interventions (93.1 %). Fibromyotomies, triceps lengthening surgeries performed at an early age (6-7 years) contribute to the development of an iatrogenic crouch gait pattern, a decrease in motor abilities and quality of life by the age of 17-18 years. The probability of maintaining a positive result and improving motor ability by the end of the childhood period is significantly higher in the subgroup of multilevel orthopedic interventions than in patients after fibromyotomies or who did not undergo orthopedic treatment; the differences are significant as the chi-square test for binary samples shows (p = 0.012).

Conclusions The severity of impairment of motor abilities, quality of life, incidence of the crouch gait pattern in patients with spastic types of cerebral palsy are close between subgroups at the time of transition to adult medical and diagnostic institutions. The quality of life and motor status after multi-level intervention improves and remains stable by the end of the childhood. Early surgical interventions for lengthening the triceps, fibromyotomy reduce motor potential in the long term, cause the development of the iatrogenic crouch gait pattern, and decrease the quality of life of adolescents with mild neurological disorders.

Introduction World literature data indicate the involvement of inflammatory cells in the pathogenesis of palmar fascial fibromatosis. However, there are no data on possible changes in peripheral blood leukocyte indices in patients with Dupuytren's contracture (DC) in comparison with healthy people.

Aim To assess the diagnostic significance of neutrophil-lymphocyte (N/L) and lymphocyte-monocyte (L/M) indices of peripheral blood in patients with CD.

Materials and methods 162 medical records of patients admitted for surgical treatment were retrospectively studied. To compare the results of their peripheral blood tests with the norm, anonymous leukocytograms of 110 apparently healthy individuals (control) were used.

Results In the group of healthy people and in patients with DC, sexual dimorphism of the absolute content of neutrophils was expressed. In DC males, a statistically significant decrease in the absolute content of lymphocytes (p = 0.05) was found, and in females, a significant increase in the absolute content of monocytes (p = 0.00) compared with the control, while in patients with DC there was no gender-related difference in these indicators, typical for healthy people. N/L ratio was elevated in DC males compared with controls (p = 0.05) and a subgroup of DC females (p = 0.01), but according to the results of ROC analysis, N/L ratio turned out to be diagnostically useless. For the model "L/M – degree of contracture" AUC 0.945, CI 0.918-0.970, p = 0, Se 90.12, Sp 93.21; optimal threshold L/M 3.102. In patients with low L/M (≤ 3.0), the frequency of lesions in both hands and the frequency of grade III-IV contractures are higher by 27.75 % (p = 0.02) and 27.15 % (p = 0.03), respectively than in the high L/M subgroup.

Discussion The multidirectional changes in the content of lymphocytes and monocytes in males and females is consistent with the literature data on dual gender-specific ways of regulating the immune system in healthy people and in patients with various diseases.

Conclusion The findings of the studied sample of patients show that the lymphocyte-monocyte index is a useful additional laboratory indicator for identifying a risk group for severe fascial fibromatosis. It can be used in clinical practice at no additional cost along with the well-known Dupuytren diathesis criteria to identify a risk group for progression of Dupuytren's contracture.

Relevance Diabetic neuroosteoarthropathy (DNOAP) complicated by chronic osteomyelitis (CO) is one of the most common complications (up to 7.5 %) in patients with diabetes mellitus. Treatment failure of such patients leads to amputation of the segment, and in some cases, to death. The use of the method of transosseous osteosynthesis is the only alternative method in the struggle for the limb salvage.

Purpose Based on X-ray morphological criteria for assessing bone quality, to determine the optimal assembly of the external fixation device (EFF), which provides favorable conditions for restoring limb weight-bearing capacity in the treatment of patients with DNOAP complicated by infection.

Materials and methods The analysis of radiographs and the clinical course of the reparative process in 49 patients (mean age 55.5 ± 9.4 years) with DNOAP complicated by chronic osteomyelitis was carried out. Two groups were distinguished based on the Ilizarov apparatus assembly: wire-based (WB) used in 25 patients; hybrid construct (HC) in 24 patients. The X-ray obtained in Jpeg format were analyzed using specialized Hi-scene software. The density of the bones of the foot was studied by MSCT.

Results Comparison of the indicators of bone optical density in both study groups showed that there was an insignificant increase in the postoperative period Od of the calcaneus by 25 % after treatment in patients from the HC group, and in the WB group by 43 % in the distal tibia. At the same time, we noted a significant increase in the Od values of the tibia in the postoperative period in patients from the HC group and in the body of the calcaneus in patients from the WB group. MSCT showed that the density of the calcaneus before treatment in patients with DNOAP in the region of the calcaneal tubercle was 194.37 ± 49.05 HU, in the region of the body it was 205.47 ± 38.36 HU, in the region of the distal tibia 280.00 ± 40.30 HU. The analysis of the results of bone osteosynthesis of the affected segment showed that the rate of satisfactory outcomes after dismantling the device in patients from the HC group was significantly higher than in the WB group (56 %) and amounted to 75 %.

Discussion As is known, pronounced osteoporosis of the bones of the lower leg and foot is often characteristic of patients with diabetes mellitus complicated by DNOAP and chronic osteomyelitis. A possible arsenal of treatment methods that allow solving the problems of stable arrest of the osteomyelitic process and restoring limb support in such patients is very limited. The optimal choice of the Ilizarov apparatus assembly type has an impact on the outcome of treatment of patients with this pathology.

Conclusion Based on X-ray morphological criteria for assessing bone quality, our study showed a decrease in optical  and densitometric bone density in patients with DNOAP complicated by chronic osteomyelitis compared to the norm. The use of wire-based assembly of the apparatus does not provide sufficient conditions for the solution of the set of the surgical tasks in this category of patients. The introduction of half-pins into the apparatus system provides the necessary fixation time with the possibility of functional load on the operated segment in patients in the postoperative period.

Introduction Despite the recognition of MRI as the gold diagnostic standard for Charcot arthropathy, there is evidence in the literature that MSCT is more informative for objective qualitative and quantitative diagnosis of the condition, primarily of the bone skeleton of the Charcot foot, in comparison with standard radiography. The sensitivity and specificity of these methods are different.

Purpose To reveal the features of organotopic remodeling of bone tissue and implanted osteoplastic material in the course of midfoot and hindfoot subtotal defects management in Charcot neuro-osteoarthropathy.

Materials and methods The analysis of bone tissue and implanted osteoplastic material density was carried out in a case series that included 11 patients with Charcot neuro-osteoarthropathy who underwent a two-stage procedure for bone defects in the hindfoot and midfoot with the Ilizarov apparatus. We studied CT and MRI scans and measured bone regenerate density before treatment, at the stages of transosseous osteosynthesis, and 3, 6, and 12 months after surgery.

Results In all patients, varying increase in the amount and volume of bone tissue was visualized due to intensive periosteal bone formation along with the formation of bone ankylosis in the joints along combined with a consistent increase in the optical density of bone regenerates. The formation of the new bone tissue ran without the signs of lysis or sequestration. The conducted studies indicate that the sizes and architectonics of bone fragments are more differentiated in CT than in MRI scans.

Discussion It is known that the bone, despite its high mineralization, continuously rebuilds, restores and adapts itself to certain functional conditions. This constant dynamic process of adaptive remodeling depends mostly on optimal blood supply, metabolic activity and the coordinated work of bone cell elements. The data obtained show angiogenesis in the compromised tissues in patients with Charcot foot and consistent remodeling of the graft into the new bone tissue.

Conclusion The allobone in the composition of the combined bone graft does not reduce the likelihood of complete remodeling of the newly formed bone tissue. Higher bone density by filling in a bone defect with a graft differs from distraction regenerate that initially has low bone density. CT and MRI are highly effective and informative diagnostic methods for surgical treatment. In reconstructive interventions in the patients with Charcot foot under the conditions of transosseous osteosynthesis, preference among radiological study methods should be given to CT.

Introduction Diagnosis of chronic periprosthetic joint infection (PJI) is difficult with the clinical signs of periprosthetic inflammation showing no growth of microorganism in the biomaterial. The frequency of culture-negative infection can reach 42.1 %. The objective of the study was to analyze outcomes of two-stage treatment of chronic PJI of the knee joint depending on the etiology of the infectious process.

Material and methods A retrospective analysis of outcomes was produced for 103 patients: group I (n=30) showing no growth of microorganisms and group II (n = 73) demonstrating positive growth of pathogens. Knee PJI was diagnosed according to the 2018 ICM criteria. A favorable outcome suggested absence of recurrence for at least two years after reimplantation of endoprosthesis, arthrodesis, “life with a spacer” without signs of infection.

Results Culture-negative infection was detected in 29.1 % (n = 30). Patients in the group were 1.5 times more likely to receive antibiotic therapy prior to admission and had average levels of CRP, ESR and articular leukocyte count being 1.5-2 times less than those in group II. Staphylococci (69.8 %) including MRSE (75 %) was the leading pathogen in group II. Recurrence of infection was 3.4 % in group I and 16.9 % in group II (p = 0.0928), the two-stage treatment was successful in 96.7 % and 74 %, respectively (p = 0.0064).

Discussion Causes for the lack of growth of microorganisms in biological materials included previous antibiotic therapy, wound drainage, violations of the rules for sampling of biological material, absence of media for the growth of atypical microorganisms and the ability of microorganisms to form biofilms on implant surfaces. An emergency histological examination of the affected tissues was practical during surgery in doubtful situations for adequate surgical approach. The results of a meta-analysis (2023) showed that the replacement of an infected endoprosthesis was more effective for the treatment of a culture-negative infection compared to debridement and preservation of implant.

Conclusion The culture-negative infection group in our series showed better success rate of a two-stage treatment of PJI using implant replacement and broad-spectrum empiric antibiotic therapy at a two-year follow-up period. The negative microbiological result in the group could be caused by antibacterial drugs administered prior to diagnosis of PJI.

Introduction The success of the treatment of patients with degenerative diseases of the spine and concomitant damage to the hip joint depends on the understanding of the biomechanics of movements in the spinal-pelvic segment. After a thorough analysis of the biomechanical processes occurring in the spine-pelvis system during the transition from a standing to a sitting position, it becomes clear that the acetabular axis of rotation of the pelvis in space is not the only one.

The purpose of the study was to develop and test a virtual model of the pelvis to study the kinematics of the movement of the spinal-pelvic complex with a description of the emergence of the iscial axis of rotation by changing the position from standing to sitting.

Materials and methods The problem was solved using the finite element method. The bones were modeled as absolutely rigid bodies. The main ligaments and muscles were modeled using finite element springs: elastic fragments with specified rheological characteristics. The study of contact interaction was carried out for pairs: "femoral head – acetabulum" and "ischial tuberosities - chair surface".

Results A new axis of rotation was revealed, the ischial axis, which corresponded to the points of initial contact of the ischial tuberosities with the surface of the chair. The axis of the acetabulum rotated by 7.1° relative to the ischial axis and at the final moment shifted in the horizontal direction relative to the acetabular axis by 8.83 mm. The gap between the surfaces of the femoral head and the acetabulum was about 8 mm.

Discussion The study shows that the pelvis rotates depending on the position around two axes: acetabular and ischial ones, hence it follows that the acetabular axis oscillates back and forth during ante- and retroversion, that is, it is non-static. Shortcomings of the model: 1) muscles and ligaments were modeled using FE springs, the end and beginning of which were set by two points, and the muscles and ligaments in the real body are attached along the entire surface of the bones; 2) soft tissues were not modeled in real volume. The merit of the study is the contact interaction of the pelvis with the chair and its rotation relative to the ischial axis, while other studies consider the rotation of the pelvis only relative to the acetabular axis.

Conclusion A new axis of rotation arises due to the contact interaction of the pelvic bone with the surface of the chair when the skeleton moves from a standing position to a sitting position, the ischial axis. The gap between the surfaces of the femoral head and the acetabulum was about 8 mm. It is advisable to conduct a clinical study.

Introduction Talus and calcaneus fractures account for about 2 % of skeletal injury and 70 % of the foot fractures. Open fractures of the hindfoot are diagnosed in 30 %. More than half of the injuries are graded as type III according to classification of R.B. Gustilo, J.T. Anderson (1976). Injury to the posterior tibial artery is observed in 6.4 % of patients. Amputations resulting from an osseous-vascular injury and gangrene and crushed soft tissues are observed in 3-60 %.

The objective was to demonstrate a rare clinical case of traumatic partial hindfoot amputation on the right side associated with open calcaneus and talus fracture and injury to the posterior tibial artery and resulted in a good outcome.

Material and methods A clinical case of a 36-year-old patient who suffered a traumatic partial hindfoot amputation and injury to the posterior tibial artery.

Results Restoration of the anatomy and the function of the right foot was achieved in the patient.

Discussion There are no clinical guidelines and a unified classification for bone and vascular injuries and no universal method for the treatment of a combined injury including an open fracture of bones and injury to blood vessels. The choice of treatment modality, diagnosis of osteovascular injuries are produced on an individual basis depending on the external and internal factors affecting the injuries. An angiotraumatological approach used to treat the patient with the hind foot injury on the right included early primary surgical treatment of the osteovascular injury, accurate reduction and stable fixation using a sparing technique for the calcaneus, repair of the posterior tibial artery, complex drug therapy to improve blood rheology, reduce coagulability, address tissue ischemia and provide adequate regional anesthesia.

Conclusion The combination of factors and use of an angiotraumatological approach employing organ sparing strategy and a multidisciplinary team of orthopaedic and trauma surgeons, angiosurgeons, anesthesiologists-resuscitators facilitated foot salvage, improved function and supportability.

Introduction Fixation of the acromioclavicular joint with Kirschner wires (K-wire) has been widely used by orthopeadic and trauma surgeons in the recent past. Now the technique is less common. Migration of Kirschner wires is a common complication being limited to the fixation area in the majority of cases and can be a devastating event in rare cases. The objective was to explore K-wire migration into the spinal canal after acromioclavicular joint repair.

Material and methods A clinical case of a broken K-wire migrated into the spinal canal is reported. An unsystematized literature analysis on the topic was performed.

Results and discussion A routine examination revealed a K-wire fragment migrated into the spinal canal at the cervical level 7 years after acromioclavicular joint fixation in a 36-year-old man. The pin fragments were removed from the spinal canal and from the acromioclavicular joint site. The postoperative period was uneventful. A good clinical result was obtained, the wounds healed by primary intention. Migration of K-wires into the spinal canal is a rare but severe complication that can lead to injury to the dura mater, the spinal cord and the vertebral artery. There are cases of wire migration reported outside the insertion site: into the lung, mediastinum, esophagus, spleen, intestines, aorta, and heart with the timing of wire migration ranging from 11 days to 12 years of surgery.

Conclusion The case report and literature review have shown a risk of K-wire migration into the spinal canal when used for fractures and dislocations. The technique requires dynamic observation of the patient throughout the treatment period. The pins should be removed after fracture healing or dislocation repair. The manipulations can minimize the risk of a fracture and migration of the K-wires.

Introduction Total counts of total hip arthroplasty (THA) have been increasing for several decades, and the procedures are associated with considerable risk of intra- and postoperative complications. Vascular complications are defined as multiple pathological conditions. They are subdivided into acute adverse events such as intraoperative bleeding, acute ischemia and hematoma and chronic complications such as pseudoaneurysms and arteriovenous fistulas which can cause late ischemic events. A specialized and well-trained multidisciplinary team is required to perform surgical interventions due to the small number of intravascular lesions. The objective was to demonstrate findings of clinical, instrumentation methods and staged treatment of patients with periprosthetic joint infection (PJI) of the hip and complications associated with injury to the great vessels.

Material and methods We report two cases of vascular complications in patients with PJI and migration of femoral components into the lesser pelvis.

Results An integrated approach to the diagnosis and treatment of patients with PJI and complications associated with injury to the great vessels helped to avoid lethal outcomes of the Girdlestone operation.

Discussion Revision THA requires careful planning and an interdisciplinary approach with the help of a clinical pharmacologist, microbiologist, plastic or angiosurgeon. PJI is associated with a high risk of recurrence that would require two-stage, three-stage surgical interventions. With the bone deficiency of the acetabulum and the proximal femur the Girdlestone operation is performed as the final procedure with resultant significant decrease in the functional adaptation of patients.

Conclusion Careful preoperative preparation of patients with unstable hip replacement components including migration of the acetabular component into the pelvic cavity and associated PJI would help to avoid such a devastating complication as great vessel injury.

Background Advanced coxarthrosis is a leading cause of disability in patients. Total arthroplasty is regarded as the "gold standard" for the treatment of hip pathologies that are not amenable to conservative treatment. Arthroplasty introduced into clinical practice has significantly improved functional status of patients. The data are largely contradictory and indicate certain difficulties and risks at the stages of treatment and rehabilitation of patients after surgery. The shortcomings can be overcome by improving the treatment methods for the cohort of patients based on the results of large-scale comparative studies exploring the effectiveness of different approaches to all stages of treatment of arthroplastic patients.

The objective was to search for the most justified and promising surgical approaches in terms of clinical efficacy and safety of total hip arthroplasty (THA).

Material and methods The search for publications was produced using the databases of Scopus, PubMed and the electronic scientific library eLIBRARY in Russian and English languages using the keywords: total hip arthroplasty, minimally invasive approach, anterolateral approach in THA, direct lateral approach in THA, posterior approach in THA, comparative assessment of approaches in hip arthroplasty, advanced replacement techniques, incidence of postoperative complications in THA, direct anterior approach in THA.

Results and discussion A number of studies have shown that interventions using direct anterior access (DAA) are characterized by less blood loss, less frequent blood transfusions, less operating time and shorter hospital stay. There was a more rapid recovery of the hip function during early postoperative period with less need for opioid analgesics with DAA. Complication rate was higher with DAA than in the comparison group, which directly correlated with the learning curve.

Conclusion DAA was shown to be an advanced approach that resulted in enhanced clinical efficacy and safety of surgical treatment in the majority of patients with coxarthrosis with sufficient experience of the surgeon. The method can be considered as low-traumatic. Unlike other approaches, DAA was accompanied by less injury to intact tissues; smaller skin incision; less blood loss; precipitated postoperative rehabilitation; less severity of postoperative pain and less need for opioid analgesia. However, DAA is inferior to classical approaches in primarily complicated hip pathologies.