Object: total hip arthroplasty at consequences of trauma of these area. Aim: to improve the results of total hip arthroplasty in patients with the consequences of acetabulum and proximal femur trauma by experimental biomechanical substantiation and development of differentiated methods of total hip arthroplasty, depending on the condition of the bone tissue and the degree of anatomical changes in acetabulum and proximal femur. Methods: clinical, X-ray, dual-energy x-ray absorptiometry, morphological, biomechanical, mathematic modeling, biochemical, statistical. It has been proved for the first time that the features of X-ray anatomical changes in acetabulum and proximal femur in patients with consequences of trauma in this area determine the tactics of total hip arthroplasty and, accordingly, allow to single out 5 groups of patients with specific X-ray anatomical changes inherent to them, namely: pseudoarthrosis of the femoral neck, pseudoarthrosis at the trochanteric level of femur, posttraumatic avascular necrosis of the femoral head, posttraumatic coxarthrosis, unreduced fracture-dislocation in the hip. For the first time, it has been found that most patients with consequences of trauma at the level of the acetabulum and proximal femur have local and systemic bone mineral density infringements. In patients with consequences of acetabulum and proximal femur trauma, the increase in interleukin-1, -4 and -6, glycoproteins, chondroitin sulfates concentrations and in alkaline phosphatase activity in serum has been detected with further decrease of this indexes after total hip arthroplasty, which indicates the decrease of the inflammatory process and the absence of postoperative complications. For the first time, basing on comparative analysis, higher biocompatibility and osseointegrative features of porous tantalum and trabecular titanium Trabecular Titanium implants have been determined by comparing with other trabecular titaniums. For the first time it has been proved that even though in conditions of osteoporosis osseointegration around implants with porous tantalum Trabecular Metal, trabecular titanium Trabecular Titanium, titanium Gription, titanium Stiktite, titanium Tritanium decreases, it is still over 50 %, which makes it possible to propose this types of implants to be used not only in case of normal bone density, but also in case of osteoporosis. It is proved that the greatest destructive loads in the conditions of normal density of bone tissue can be withstood by bones with implants made of porous tantalum Trabecular Metal and titanium Stiktite; in case of osteoporosis bone – metal block with porous tantalum Trabecular Metal proved to be the strongest. For the first time, with the help of the developed mathematical model of the pelvis and hip joint in three phases of human movement, it has been proved that at total hip arthroplasty in conditions of osteoporotic bone tissue and traumatic consequences in the acetabulum and proximal femur general level of stress-strain state in hip joint area is significantly increased. Additional stress concentration zones are localized on the acetabular walls and in the affected areas of acetabulum and proximal femur. It has been shown that reconstruction of these defects, enhancing of acetabulum walls, use of stems of the proposed design significantly reduces the level of stress in the acetabulum and proximal femur. Basing on the obtained experimental-morphological and theoretical data, differentiated methods of total hip arthroplasty in patients with consequences of trauma in the hip joint area have been developed depending on the condition of the bone tissue and the degree of anatomical changes of acetabulum and proximal femur, the use of which can improve the outcome of treatment and quality of life of such patients. The developed methods of postoperative rehabilitation of patients with the consequences of acetabulum and proximal femur trauma allow early renewal of the function of the affected hip joint, bringing the patient back to socially active life and restoring patients’ efficiency. The results of the research are introduced into the clinical practice of the Kharkov Regional Clinical Traumatology Hospital, the SI "Sytenko Institute of Spine and Joint Pathology of the National Academy of Medical Sciences of Ukraine", KZOZ "Regional Clinical Hospital - the Center for Emergency Medical Care and Catastrophe Medicine", hospitals of intensive care "Kremenchutsʹka". Traumatology and Orthopaedics.
