HIP JOINT REPLACEMENT IN A PATIENT WITH TRANSTROCHANTERIC FRACTURE AT THE BACKGROUND OF BONE ANKYLOSIS
An increase in the frequency of fractures of the proximal femur leads to the need to improve the tactics of their treatment. Particular complexity for selection of surgical techniques is associated with fractures against the background of hip ankylosis. The most rational method of treatment is hip replacement with the use of systems with a pair of friction with double mobility, which reduces the risk of dislocations of the components of the hip replacement against the background of ankylosis. Objective - to determine the indications for primary hip arthroplasty in patients with trochanteric fractures associated with bone ankylosis, to evaluate the results of this method of surgical treatment and to identify disadvantages. Materials and methods. The results of two cases of total hip arthroplasty for transtrochanteric fractures against the background of bone ankylosis are described. Before the injury, both patients had established bone ankylosis in a functionally disadvantageous position, namely adduction, external rotation, and limb shortening. Results. The patients were activated on the second day after the operation, and the results were assessed according to the Harris score at discharge on the 9th day. The score was 60 points, two months after surgery - 76 points, after 12 months - 91 points. The data obtained confirm the validity of the application of this method of treatment of the fractures of the proximal femur against the background of ankylosis, since most iatrogenic arthrodesis procedures for the hip joint eventually become ankylosis in a functionally disadvantageous position - in adduction and external rotation. This approach will allow not only to reduce the frequency of unsatisfactory functional results of arthroplasty, but also to prevent the development of irreversible degenerative-dystrophic lesions of adjacent segments, thereby reducing the terms of social and household rehabilitation of patients in this category. Conclusion. When choosing the option of surgical intervention, one should take into account the etiological factor of the ankylosis formation, as well as the individual characteristics of each particular patient, taking into account the limiting factors.