In the human musculoskeletal system, the knee joint is the most overloaded. Often, it accounts for the bulk of the body, so it is more vulnerable to disease and more likely to be destroyed.
Under the influence of age and various factors (ruptures of the inner meniscus of the knee, trauma, infectious and inflammatory processes, hypothermia), the cartilage tissue becomes thinner, and the end bones begin to rub against one another. This provokes injuries, limits movement in the joint and causes excruciating pain to a person.
If conservative methods of treatment are no longer able to cope with the problem, doctors offer the patient a knee replacement.
The operation is indicated in the following situations:
- the presence of arthrosis, that is, degenerative-dystrophic diseases of the joint;
- rheumatoid arthritis;
- post-traumatic abnormal fusion of the bones included in the knee joint.
The endoprosthetics operation lasts an average of 2 hours. The patient is given general anesthesia or a nerve block is performed, which continues to relieve pain within 24 hours after surgery.
To penetrate into the joint, an incision is made above it, the patella is carefully moved to the side. The doctor removes excess bone formations formed as a result of rubbing the end bones against each other. These growths are a kind of protective reaction of the body.
In addition, the surgeon loosens the tension of the periarticular soft tissues, which returns diarthrosis to its original state.
The worn-out remnants of cartilage tissue are carefully cut off, and a perfectly fitted prosthesis is implanted in its place. Moreover, the end bones are covered with special metal nozzles:
- a titanium plate is placed on the tibia;
- on the femur - an anatomically adapted prosthesis.
Additional inserts are attached to the titanium plate to ensure smooth movement in the joint. A special bone cement is used to fix the knee joint prosthesis. In some cases cementless fixation is used. The operated joint is then sutured and immobilized with a plaster cast or splint.
The operation to replace knee diarthrosis provides the patient with complete freedom of movement and relief from excruciating pain in the future.
Advantages and disadvantages of prosthetics
Endoprosthesis replacement of the knee joints has its advantages and disadvantages. The absolute advantages include the disappearance of pain and lameness, the return of the joint to full functionality.
The negative factors of arthroplasty include the likelihood of infection, although statistics state that the percentage of probability of such a course of events is very low.
Rehabilitation after arthroplasty takes a rather long period of time - about two months. During this time, the patient must get used to the prosthesis and learn how to freely manage it.
Many doctors are supporters of arthroscopy - this is an operation with minimal trauma. In addition, recovery after arthroscopy occurs much faster than after conventional prosthetics.
It is indicated for minor injuries in the joint, when the restoration of cartilage tissue in the knee is still possible by taking special medications and a set of other measures.
During arthroscopy, the doctor:
- right dislocation;
- removes bone growths;
- relieve tension in the muscles around the joints.
In the case when the cartilage tissue is damaged thoroughly, this operation provides only temporary relief.
It is not uncommon for patients who have undergone knee replacements to panic when the prosthesis is wedged. Unfortunately, this situation is not excluded and it is due to the improper functioning of the periarticular muscles.
If pain appears, it cannot be tolerated, you should try to take the most comfortable position and try to move your leg. If the jamming has not disappeared, then you need to contact an orthopedist. The situation is quite fixable and is not critical.
After surgery, there is a possibility of thrombosis and inflammation in the articular tissues. Therefore, the patient must first weigh all the pros and cons that prosthetics entail.
Endoprosthetics of the knee joint is categorically contraindicated for people suffering from cardiovascular pathologies and chronic joint infections.
What not to do after arthroplasty
- the process is quite lengthy. However, the patient can take the first steps after 2-3 days. Sports activities after knee arthroplasty are allowed only after a few months, and you must first consult with your doctor and get his approval.
You will have to forget about big sport after arthroplasty forever. However, therapeutic exercises are not only not prohibited, but also recommended. It is necessary for the development of the knee joint from the first days of recovery.
Physiotherapy procedures during knee replacement are prohibited in the first months, and in the future they are also undesirable. Because of the metal elements, magnetic resonance therapy can cause intense pain and tissue damage around the prosthesis.
Warm baths, saunas, steam baths and massages are also prohibited in the first months after prosthetics. These activities increase the likelihood of thrombosis. The diet for patients with an endoprosthesis should be sparing and consist of:
- lactic acid products;
- jelly.
After implantation of a knee joint endoprosthesis, a person can perform almost all the same actions that were available to him before the replacement of the joint.
But still there are some limitations. For an artificial joint, the following actions are unacceptable:
- excessive loads;
- squats with weight;
- running on sloping and uneven roads.
Rehabilitation after prosthetics
Rehabilitation of knee joints takes different periods of time for different people. Some patients walk well within a week, while others take several months to fully recover.
Properly selected physical activity is necessary to ensure that the joint becomes accustomed to the endoprosthesis and that it becomes overgrown with muscles. Rehabilitation of the patient in a special sanatorium-resort institution is recommended, where he will receive a full recovery complex of procedures and measures.
Under the supervision of medical staff and in a comfortable relaxing environment, the patient:
- take a course of physiotherapy exercises;
- take mineral baths;
- will swim in the pool;
- will receive proper nutrition in the sanatorium canteen.
Therapeutic exercises after knee prosthetics are performed by the patient from the first days of recovery. At first, the movements should be light and gentle, but over time, the doctor will create an individual complex consisting of muscle stretching, exercises to strengthen the gluteal muscles and the inner surface of the thigh.
At first, gymnastics is performed only while sitting or lying down. However, when the joint is fully restored, and there is no inflammatory process, standing and walking exercises are possible. Aqua aerobics and swimming provide excellent results, but these activities must be approved by a doctor.
Knee arthroplasty provides the patient with the opportunity to return to a full life and feel free to move, and not a disabled person, immured in his own body.
The formation of the hip joint (JJ), which belongs to simple synovial joints, occurs with the participation of two articulating bones - the ilium and femur.
The cup-shaped recess on the outside of the pelvic bone (acetabulum) and the spherical bone of the femoral head together form the hip joint, which is a kind of hinged structure.
The head of the femur is connected to the femur by a neck, which is colloquially called the "femoral neck". The inside of the acetabulum and the femoral head itself are covered with a layer of special articular cartilage (hyaline).
Cartilage is an elastic and, at the same time, a strong and smooth layer in the joint. Provides sliding during the operation of the joint, releasing the joint fluid, distributes the load during movement and the necessary cushioning.
Around the head of the joint is a capsule consisting of a very dense and durable fibrous tissue.
The joint is fixed with the help of:
- Ligaments. External are attached at one end to the femur, the other - to the pelvic. And the internal ligament of the head of the pelvic bone connects the head itself with the acetabular recess of the pelvic bone.
- Muscles. They surround the hip joint - the buttocks in the back and the femurs in front. The better developed the muscular frame of the joint, the less traumatic loads on it when running, unsuccessful jumps and moving weights. It is also important that a good volume of strong working muscles delivers a sufficient amount of nutrients to the joint with blood.
With the help of the hip joint, a person is simultaneously provided with the following functionalities:
- body stability (support, balance);
- variety of movements.
Why is the joint affected?
The obvious causes of injury include injury. Examples are hip fracture, hip dislocation or subluxation.
To non-obvious - diseases (infectious and non-infectious arthritis, osteoarthritis, inflammatory processes in the joint and periarticular tissues).
Consider the main ones:
- inflammation of the pelvic joint - usually caused by arthritis of various etiologies, bursitis, synovitis, etc .;
- pathology of joint deviation - dysplasia;
- necrosis in the head of the TS of some parts of the bone marrow - non-infectious necrosis (avascular).
When and who needs a hip replacement
The occurrence of pain in the hip joint is a signal that you should contact a professional to determine its causes. For this, at the initial stage 
X-ray examination of the vehicle should be performed.
The solution to the problem of a worn or irretrievably injured joint can be arthroplasty, which can be indicated in such cases:
- non-union fracture of the head of the vehicle;
- fractures of the femoral neck or acetabulum in elderly patients;
- aseptic necrosis;
- tumor-like diseases of the TS;
- deforming arthrosis of the third stage;
- congenital dislocation of the hip, etc.
What types of operations does medicine offer
In the conditions of modern medicine, patients are offered three types of operations by type of prosthetics:
- Replacement of the surfaces of the TS - removal of cartilaginous layers from the acetabulum with replacement with a special artificial material and turning of the femoral head with a metal cap put on it. Gliding, thanks to this replacement of articular surfaces, is achieved close to natural.
- Partial prosthetics - replacement, for example, of the head of the pelvic joint with part of the neck of the femur, the articular bed.
- Complete prosthetics - removal of the entire hip joint and its replacement with an EP (endoprosthesis).
Types of endoprostheses
In modern medicine, there are more than six dozen modifications of endoprostheses today. They are divided according to the method of fixation and material. Three methods of fixation are offered today:
- cementless - fixation occurs due to the fact that the joint bone grows into the surface of the EP;
- cement - the endoprosthesis is fixed using a special bone cement;
- mixed (hybrid) - the cup is attached without bone cement, and the leg - with cement.
Modern combinations of materials from which prostheses are made are selected depending on the patient's disease, age and lifestyle. They may be:
- metal - metal;
- metal - very high quality plastic;
- ceramics - ceramics;
- ceramics - plastic.
Preparing for the operation
All the necessary information on preparation for the operation will be presented to you by the attending physician.
However, there are moments for which the patient will have to prepare in advance (especially for those who are alone).
Since rehabilitation after the replacement of the joint continues at home, it is worth preparing your home for the postoperative recovery period:
- purchase special equipment in the form of walkers or crutches, a special toilet seat, etc.;
- stop taking certain drugs (aspirin-containing, anti-inflammatory);
- if necessary, reduce your weight;
- engage in physical training;
- visit the dentist;
- give up bad habits (smoking).
Before the operation, the patient is obliged to draw up the necessary documents (carrying out the operation for cash, under a contract within the framework of medical insurance or according to quotas of the federal program for the provision of free high-tech medical care); Talk to your anesthesiologist about the type of anesthesia that is best for you. stop eating at least 12 hours before surgery.
Joint replacement surgery
Modern advances in medicine make it possible to perform both open surgeries for hip arthroplasty, as well as minimally invasive and minimally invasive ones.
Today, minimally invasive operations (MO) are the most common because of their minimal impact on the body.
To conduct MO, you need:
- high qualification and professionalism of the surgeon and all medical staff;
- availability of technical capabilities (endoscopic equipment, high-tech materials).
Depending on the complexity of the operation (partial or complete prosthetics), its time can last from one to three to four hours:
- anesthesia;
- installation of a catheter in the urethra (to prevent involuntary urination and control the amount of fluid secreted by the body);
- an incision from the outer part of the thigh (or two small ones - on the thigh and in the inguinal region);
- exfoliation and shift of tissues around the vehicle;
- installation of a prosthesis;
- restoration of tissue integrity and wound closure.
The video clearly shows how the hip arthroplasty is performed.
Possible Complications
Any surgical intervention in the body can have its negative consequences. Complications after the procedure most often occur in operated patients:
- with a large deformity of the joint;
- with obesity or large muscle mass;
- having a number of serious concomitant diseases - diabetes, diseases of the blood, heart and entire cardiovascular system, etc.
Joint replacement can cause the following complications:
- incorrect position of the endoprosthesis;
- damage to nerve fibers, arteries;
- violations of the process of postoperative wound healing;
- the occurrence of infections;
- fracture of the femoral bone, dislocation or "popping" of the prosthesis;
- thrombosis in deep veins.
Rehabilitation after surgery
Rehabilitation after arthroplasty can be long and take up to 6 months.
The patient should monitor the seam, body temperature and his feelings. Pain during this period can pass and return, the patient must be prepared for this and make efforts to fully restore the motor functions of the body.
The first few days the patient is prescribed painkillers, anti-inflammatory drugs. 
Further rehabilitation after hip replacement consists in prescribing special light gymnastics and breathing exercises.
To prevent cicatricial contractions of the tendons and skin, to strengthen the muscular frame around the prosthesis, the patient is prescribed physiotherapy exercises (exercise therapy).
As the reviews of patients who underwent arthroplasty indicate, it is worth adhering to the recommendations of specialists as much as possible and then rehabilitation will be quick and almost painless.
How is rehabilitation after surgery on the hip joint described in detail in the video.
Where can I have an operation in Russia
The operation for prosthetics of the TS is a high-tech process.
In 2015, the inclusion of high-tech medical care (HMP) in the system of compulsory medical insurance is provided for by the new legislative draft “On Compulsory Medical Insurance in the Russian Federation”.
Therefore, here we will not specify who will pay for the operation - the patient or insurance companies.
The cost of a hip replacement is made up of the prosthesis and the operation itself. To date, the cost of the operation (total hip arthroplasty) ranges from 210 to 300 thousand rubles (depending on the cost of the prosthesis).
Hip replacement in Russia is performed both in federal budgetary healthcare institutions (Federal Center for Traumatology, Orthopedics and Endoprosthetics, regional clinical hospitals, research institutes) and in private clinics of the Russian Federation.
For example:
- OAO "Medicine";
- Clinic Family;
- City Clinical Hospital No. 67 (Moscow);
- KB MGMU them. Sechenov;
- SM Clinic;
- Central Design Bureau of the Russian Academy of Sciences;
- Multidisciplinary medical center "K + 31";
- DKB im. Semashko;
- Central Design Bureau No. 2 of Russian Railways, etc.
Paget's disease is a disease in which there is a pathological proliferation of the bone tissue of the skeleton and its deformation due to a violation of the structure. This disease occurs as a result of a violation of the regenerative process in the bones, it is chronic. Otherwise, such a disease is called "deforming osteodystrophy" or "deforming ostosis".
Most often, the disease affects the bones of the lower leg and spine, collarbone and skull, hip and shoulder bones. Persons over 40 years of age and mostly men suffer from this disease, women are 50% less likely. The population of Europe is most susceptible to this disease.
Medicine does not know the exact causes of this disease, but there is an assumption that the following factors contribute to its occurrence:
- various conditions leading to a violation of the metabolism of phosphorus and calcium in the body;
- transferred diseases of a viral nature;
- the presence of viruses in the body in an inactive phase;
- hereditary predisposition.
Sometimes the cause of Paget's disease is a combination of all of these causes. If hereditary predisposition prevails, then it is advisable for the family members of the sick person to undergo an x-ray examination of the bones and monitor the level of alkaline phosphatase by taking a blood test. A special place in a number of viral causes of the development of this disease is given to the measles virus.
Paget's disease occurs in two forms: monoosseous and polyosseous. The monoosseous form of the disease is characterized by damage to one bone, with the polyosseous form of deformation, several bones are exposed. The main difference between this type of disease and other bone diseases is that there are no generalized bone lesions - the disease affects only certain parts of the skeleton. It is known that such bone disease causes a continuous process of bone tissue change without any impact on it. It is believed that the disease can develop into bone sarcoma.
In its course, the disease goes through three stages:
- initial;
- active;
- inactive.
The initial or osteolytic stage is characterized by a peculiar resorption of certain sections of the bone, as a result of which hollow pits form at this site. At the active stage, this process continues and at the same time the growth of bones occurs - they begin to acquire a cellular structure.
At the third stage - inactive - the bone tissue is replaced by connective tissue, i.e., osteosclerosis develops. In this case, the surface of the bones becomes rough, due to their thickening, the mass decreases. If the tubular bones were affected, then they are bent and bent. When the disease affects the bones of the skull, their thickening up to 5 cm is noted, which in turn entails a deformation of the face and head. In case of damage to the bones of the spine, the spinal column is deformed and curved.
The onset of the disease occurs without any symptoms, such an asymptomatic course is quite long. Signs and symptoms of the disease appear gradually.
Its first manifestations can be detected when the patient examines other pathological conditions, that is, they learn about the disease only when they take a blood test, when a change in the indicator responsible for the metabolism in bone tissue, phosphatase, is accidentally detected. In addition, a sign of such a disease is the deformation of the bones.
Pain in the area of the affected bone is the main symptom of the disease.
The pain is usually continuous, aching and dull. Its feature is that it does not subside after rest, but rather increases at rest. If the disease occurs near the joint, the patient may complain of osteoarthritis. In addition, stiffness of movements is characteristic, the mobility of the joints in the affected bone is limited.
With an approximate and detailed examination, swelling can be seen in the lesions, the skin in this place is changed - there is hyperthermia of a separate area and its redness. If the doctor feels the affected area, then thickening of the bone and unevenness of its edges may be noted. With slight pressure on such a bone, it can break.
As a result of the disease, bone fragility and bone fractures are noted, even as a result of a minor injury. When the spine is damaged, the back becomes deformed, stooped. In this case, the legs are bent and an abnormal growth of the bones of the skull is observed. Deformities of the bones of the skull and spine can cause hearing or vision loss. This can occur as a result of compression of nerve endings by deformed bones. For the same reason, the patient may complain of constant headaches, numbness of the limbs and a feeling of "goosebumps" on the skin.
Diagnosis of the disease occurs by biochemical analysis of blood and x-ray examination of the bones of the skeleton. If there is a disease in the results of a blood test, the alkaline phosphatase enzyme in the blood serum will be higher than normal. If such an increase is detected, it is necessary to regularly take a blood test to monitor possible changes.
X-ray examination is a very reliable and informative method for diagnosing bone diseases.
In the picture in the presence of the disease, the following features will be noted:
- skull bones are enlarged;
- looseness of the bone structure;
- increased intracranial pressure;
- an increase in the size of tubular and pelvic bones;
- thickening of the periosteal layer;
- decay and deformation of bones;
- fractures.
Diagnosis of Paget's disease can be made using methods such as computed tomography and MRI. Their use is advisable only in cases where no pathology was detected on the x-ray. For diagnostic purposes, the method of scanning bones with technetium is also used. It allows you to identify foci of bone tissue with pathological changes and to dynamically monitor the course of the disease under the influence of medical procedures.
Until the disease has manifested itself in full force and is asymptomatic, no treatment is required. Basically, the disease requires symptomatic treatment. When pain occurs, analgesics and non-steroidal anti-inflammatory drugs (Diclofenac, Ibuprofen) are used. In addition, the use of vitamin D and calcium is recommended.
If there is a change in gait caused by deformity of the bones of the lower extremities, the doctor may recommend the use of orthopedic products. In some cases, this disease requires orthopedic surgery - arthroplasty or decompression. With a significant deformation of the hip joint, it can be replaced, since this will significantly improve the quality of life of the patient and relieve him of pain. This procedure is called arthroplasty. Treatment of Paget's disease also includes exercise with physical activity. It is not recommended to spend a long time in bed, as the pain intensifies at rest.
An obligatory element of therapy is the use of special drugs, the main action of which is aimed at slowing down the process of bone tissue destruction. These are drugs - bisphosphonates, their use should be long-term. These medicines have their own side effects and therefore their prescription should be carried out by a doctor.
Conclusion on the topic
So, bone disease affects mainly older people and is associated with a violation of the process of bone tissue regeneration. Individuals at risk for developing Paget's disease should have regular check-ups. Its main symptoms are pain and bone deformity.
It is impossible to completely cure the disease, but it is quite possible to slow down its course for a long time. The disease under the influence of treatment stops its progression, but already existing pathological changes are irreversible. The duration of the course of treatment is approximately six months and is repeated as needed.
The magnetic field attracts metal objects, heats up some alloys. The presence of titanium, steel pins, endoprostheses in the body raises doubts about the possibility of performing the procedure. MRI during menstruation is prescribed carefully after evaluating the indications and contraindications. Doctors of the medical profile are not familiar with the possibilities of the method, they often consider arthroplasty (replacement of joints with artificial analogues) as a contraindication to magnetic resonance imaging.
The approach is not rational. It is required to know the composition of the plate. They are made of titanium, metal alloys, plastic inserts. Technological progress contributes to the creation of new models from different components. The impact of such structures with powerful magnets has not been studied enough. Determining indications for performing magnetic resonance imaging requires studying the chemical composition of the model, density, location, shape.
Is it possible to do an MRI with metal and titanium plates in the leg
Obtaining MR tomograms is based on the registration of a radio frequency signal after exposure to a high magnetic field. The nuclear resonance of hydrogen protons makes it possible to obtain a high-quality image. The effect works in liquid tissues. Bones contain a small concentration of water, so it is better to examine them using computed tomography (CT).
Before scanning, you need to carefully analyze the contraindications:
- The presence of prostheses of the knee, hip joints;
- Metal implants of the middle ear;
- Pacemakers, pacemakers;
- Vascular clips;
- Screws, pins.
To determine whether it is possible to do an MRI with vascular stents for a person with plates, the doctor of radiation diagnostics will be able to. Analyzing the course of physics, all metals can be divided into 3 types in relation to magnetization - ferromagnets, diamagnets, paramagnets.
Under the influence of a strong magnetic field, alloys of nickel, cobalt, and iron move. Pins, screws, joint prostheses are made of metals. Steel is a cheap material widely used in surgery. The manufacturer's instructions determine the qualitative composition of the product. The content of ferromagnets varies, so products in a magnetic field behave differently:
- Get warm;
- Move.
Who should not have an MRI after arthroplasty
Traumatologists for dynamic monitoring of the state of the product are assigned to MRI people. Even 3 Tesla field tomographs will not be able to move prosthetic joints due to strong fixation. Research with high-field devices with a power of 1.5 Tesla is affordable, characterized by a weaker attraction.
The second important issue should be solved - heating the vascular clip installed during the operation. Practical studies show an increase in the temperature of a metal wire up to 45 degrees (about 20 meters long).
The presence of an artificial prosthesis is not a contraindication. Before the appointment, you need to exclude clips, heart rate stimulators.
You can not do an MRI with an endoprosthesis, pins, screws for the elderly. Reduced bone density contributes to poor fixation of the implant. Moving metal can damage surrounding surfaces.
Steel structures are ferromagnets that can be strongly attracted. Titanium is a paramagnetic material that does not heat up and is able to move.
There is a metal plate in the leg - is it possible to do an MRI
The danger of steel models is heating under the influence of a strong magnet. The likelihood of complications increases the longer the plate. Patients are scanned under control. The person is located on the diagnostic table, holding a special button in his hand. When a feeling of warmth appears, pressing the button calls the staff, the examination stops.
The danger is represented by concentric structures such as the Illizarov apparatus. Bulky, high metal content contributes to heating. However, MRI while wearing the product is done. Concentric circles are on the outside of the leg, they do not pose a health hazard.
Before deciding whether to do a tomography of the joints after surgery, you should find out the composition of the structure. Endoprostheses are made of metal, titanium, chromium-molybdenum-cobalt alloys. The last options do not move, they warm up. They do MRI with crowns, titanium implants. 
X-rays must be taken prior to scanning. The study will show the dimensions, the number of artificial inserts (plates, prostheses, screws, screws). Even if a person has chromo-cobalt endoprostheses, additional metal fragments may be a contraindication.
Attention! Non-informative magnetic resonance imaging of the area with a metal implant. The device distorts the signal. There is a lot of noise on the final tomogram.
Titanium rod - is it possible to do magnetic resonance imaging
Elderly people should not have an MRI with a steel or titanium plate close to the skin surface. Do not scan people with metal inserts located near the tendons. Heating the device will cause damage to the articular-ligamentous apparatus. Steel structures can be removed before tomography.
The titanium plate is inert with respect to the magnetic field. The absence of movement, warming up allows for MRI diagnostics without consequences. Sometimes screw-retained titanium products are removed in younger people to minimize side effects. Senior citizens should be especially careful.
Contraindications for MRI of the joints are determined prior to the procedure.
Metal in the body and leg - what kind of MRI can you get
An MRI should be done in the presence of metal in the leg and body after determining the composition of the alloy - titanium, chromium, molybdenum have different magnetic characteristics. A certain role is played by the placement of the plate - inside the bone, near the skin.
The final decision rests with the radiologist. Bring the manufacturer's instructions for the endoprosthesis to the specialist. It is necessary to analyze the features of surgical intervention, the quantity and quality of steel fragments.
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Planning and monitoring the results of hip arthroplasty using computed tomography and magnetic resonance imaging
Recently, in traumatology and orthopedics, there has been a wider introduction into everyday clinical practice of such highly informative radiation methods as computed (CT) and magnetic resonance imaging (MRI). In the present work, we analyzed the effectiveness of using CT and MRI in tanning and monitoring the results of hip arthroplasty. In the preoperative period, CT was performed in 53 patients, and MRI - in 37 patients. Of these, in 34 cases a comprehensive examination was carried out using both methods.
As a result of the analysis of the obtained data, the following conclusions were made. The use of CT when planning surgery allows more accurate assessment of the bone structure and dimensions of the acetabulum, proximal and distal parts of the femur, to identify the location and size of cystic cavities, bone defects and other pathological changes. The use of MRI helps to clarify the diagnosis, as well as visualization of soft tissue structures and the location of the main neurovascular formations. It should be noted that early signs of aseptic necrosis of the femoral head were identified in 7 cases using MRI, despite the fact that, according to CT, no pathological changes were detected.
In the postoperative period, only CT was performed to control the correct location of the endoprosthesis components (in 21 patients after hip arthroplasty). Using a special protocol for sequential axial sections at 5 levels, the location of the components of the hip joint endoprosthesis was clarified. The acetabular component was located at an average angle of 42 to 60°, with an anteversion of 8 to 23°. When assessing the location of the femoral component, it was found that in most cases the implantation of the endoprosthesis stem was satisfactory. Only in 1 observation was noted a slight varus deviation from the longitudinal axis of the femur by 3°. In addition, functional CT was performed in 9 cases to clarify the strength of fixation of the femoral component and early diagnosis of the development of instability. Functional CT was performed according to the following technique. After constructing a standard skiagram, a set of sections was made at the level of the femoral component and at the level of the femoral condyles. At the same time, sections were made in three series: with the neutral position of the lower limb, with external and internal rotation. After that, the deviation of the axis of the femoral component was measured in comparison with the condyles in all three series of sections.
As a result of the analysis of the obtained data, the following conclusions were drawn. CT allows a more accurate assessment of the size and structure of the bone tissue, which undoubtedly helps to plan the operation more correctly. MRI should be performed, if possible, in all patients for an earlier diagnosis of aseptic necrosis, even with a negative tonic reaction, which corresponds to the pathomorphological process of lipoid degeneration. According to the qualitative study of these muscles, a significant difference was also found in the pattern of location, density of foci of muscle dystrophy, their predominant localization, the state of the fascia, epi- and perimysium.
A. N. Bogdanov, S. A. Borisov, P. A. Metlenko
Military Medical Academy. S. M. Kirova, St. Petersburg State Healthcare Institution "City Hospital No. 26", St. Petersburg
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