The role of arthroplasty in the treatment of hip osteoarthritis

Authors:

Khaydarov Valery Mikhailovich, PhD in Medical sciences, North-Western State Medical University named after I.I. Mechnikov, 41 Kirochnaya Street, 191015, St. Petersburg, Russian Federation; e-mail: drxaydarov@mail.ru; https://orcid.org/0000-0002-0754-4348.

Tkachenko Alexandr Nikolaevich, Grand PhD in Medical sciences, Professor, North-Western State Medical University named after I.I. Mechnikov, 41 Kirochnaya Street, 191015, St. Petersburg, Russian Federation; +79112151972; e-mail: altkachenko@mail.ru; https://orcid.org/0000-0003-4585-5160.

Urazovskaya Irina Leonidovna, PhD in Medical sciences, North-Western State Medical University named after I.I. Mechnikov, 41 Kirochnaya Street, 191015, St. Petersburg, Russian Federation; e-mail: langelova@yandex.ru; https:// orcid.org/ 0000-0003-4165-4599.

Mansurov Djalolidin Shamsidinovich, PhD in Medical sciences, Samarkand State Medical University, 18 Amir Temura Street, 140100 Samarkand, Uzbekistan; e-mail: jalolmedic511@gmail.com; https://orcid.org/0000-0002-1799-641X.

Balgley Alexander Germanovich, North-Western State Medical University named after I.I. Mechnikov, 41 Kirochnaya Street, 191015, St. Petersburg, Russian Federation; e-mail: alexbalgley@yandex.ru; https://orcid.org/0000-0003-0964-6871.

Totoev Zaurbek Arturovich, State Budgetary Healthcare Institution “City Polyclinic No. 112”, 25 Akademika Baykova Street, 195427 St. Petersburg, Russian Federation; е-mail: zaurbek.totoev@yandex; https://orcid.org/ 0000-0003-4514-2240.

Annotation:

Introduction. Hip replacement with an endoprosthesis has now become the surgery of choice in orthopedic practice for severe osteoarthritis. However, arthroplasty does not always allow achieving positive results, and the service life of the implant is not unlimited. In recent years, publications devoted to the limitation of indications for endoprosthetics in osteoarthritis of the hip joint have been increasingly appearing. The use of modern conservative technologies and organ-preserving surgical interventions can delay or in some cases avoid hip arthroplasty.

Aim. To analyze publications devoted to determining the place of endoprosthetics in the structure of treatment of osteoarthritis of the hip joint.

Materials and methods. Literature data was searched in the open electronic databases of scientific literature PubMed and eLIBRARY. The search was carried out by keywords and phrases: osteoarthritis of the hip joint, conservative treatment, minimally invasive surgery, hip arthroplasty. The search depth was 20 years.

Results. Complications of hip replacement range from 2 to 27 %. The structure of the negative consequences of arthroplasty is heterogeneous. This may be a deep infection of the surgical intervention area, a periprosthetic fracture, instability of the endoprosthesis, wear of its components, etc. Numerous studies indicate an increase in the number of patients who are not satisfied with the results of arthroplasty both in the short term (in the presence of complications) and in the long term after surgery, due to the natural wear process of the prosthesis. The results of studying this problem lead to the fact that in some cases the replacement of the hip joint with an implant was carried out unreasonably.

Discussion. Nowadays the possibilities of therapeutic methods for the treatment of osteoarthritis of the hip joint have significantly expanded. The use of drugs from the groups of nonsteroidal anti-inflammatory drugs, glucocorticosteroids, structural modifying drugs, PRP treatment, autologous chondrocyte transplantation, local therapy and physiotherapy, as well as minimally invasive surgery provide patients with a chance to maintain the functional activity of their own joint, and in the future to avoid or significantly delay the need for arthroplasty.

Conclusion. The most optimal strategy for managing patients with osteoarthritis of the hip joint is a comprehensive treatment using modern conservative and organ-preserving methods, which in many cases, due to the effect on various pathogenetic links, can not only improve the clinical and functional condition of patients, but also slow down the progression of the disease. Hip replacement as a non-organ-preserving operation should be considered as a last resort, mainly in elderly and senile patients, as well as in the absence of the effect of conservative treatment.

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