Torchinsky V. Biomechanical preconditions of development and features of dysplastic coxarthrosis course in adults and their influence on treatment strategy

The dissertation work contains a new approach to solution of a significant scientific problem that provides improvement of treatment results of dysplastic coxarthrosis in adults. The investigation is based on mathematical biomechanical modelling including the analyses of clinical manifestations, anamnesnic data, roentgenomorphometric parameters and treatment results of 375 hip joints in 303 patients with dysplastic coxarthrosis. As a result of the investigation mathematical biomechanical model of dysplastic hip joint has been developed that represents correlation of forces in the contact region between head of the femur and acetabulum providing possibility of quantitative description of pathologic changes in hip joint depending on its roentgenomorphometric parameters and patient's body mass taking into consideration elasticity modulus of cartilagenous tissue. Besides, the model of acetabulum with implanted acetabular component of prosthesis has been designed that allows to determine the zones of stress loads arising at the sites of adjoining head and prosthesis calyx depending on the degree of acetabular dysplasia. On the basis of presented mathematical model, anаmnestic data, the analysis of course features of dysplastic coxarthrosis and the results of carried out treatment most significant roentgenomorphometric markers of disease have been determined and prognostic system of its progress has been developed. Carried out investigation of dysplastic coxarthrosis in adults allowed to study biomechanical function of hip joint under conditions of irregular load and to ground mathematically the mechanism of contralateral joint lesion. For application in practical work of the orthopedist a classification of hip joint dysplasia in adults has been proposed where the degree of acetabular dysplasia and the degree of proximal part of femur have been considered separately including the scheme of choice and the technique of dysplastic coxarthrosis treatment.