The dissertation is devoted to the urgent scientific and practical problem -
the optimization of medical and diagnostic complex by means of improvement of
early diagnosis of hip joint dysfunctions, as well as the improvement of currently
used minimally invasive surgery techniques, which will make possible to decrease
a number of patients requiring total hip replacement, and to slow down the
development of disability. A number of typical reactions of capsule tissue of the
affected joint, specific to chronic inflammation, could be seen. The rate of
morphological changes indicative of the damage to acetabular labrum of posttraumatic genesis was found to be 94.3%, and idiopathic coxarthrosis with primary
dystrophic and necrotic changes as well as destruction of articular cartilage was
observed only in 5.7% of cases. In 70 cases (92.1%) acetabular labral tears were
accompanied by femoroacetabular conflict and were treated as traditional
lacerations secondary to traumas or degenerative changes.
Mathematic modeling of interaction pattern between the main elements of
healthy hip joint and that with acetabular labral damage in coxarthrosis
demonstrated, that in solution of its continuity, some synovial fluid goes from the
central to the peripheral compartment, and articular surfaces of the bones start
moving closer until the moment of “dry” touch. The tension on contact surface so
far ticular cartilage of femoral and hip bones with a cetabular labral damage is 8.8-
11 times higher compared to the tension in the healthy hip, causing significant
friction forces, overstrain, progressive degradation of articular
cartilageand,eventually, advancingof hip osteoarthrosis.
The analysis of change sintemporal and dimensional parameters of
walking patternin the patients with idiopathic and post-traumatic coxarthrosis
demonstrated biomechanical abnormality of walking to be one of the early signs of
primary (pre-radiologic) stages of the disease. At early stages of coxarthrosis the
integral sign of walking quality (FAP sign) proved to be 87.74±24.08, being 9.2%
lower compared to that in healthy individuals. Disturbances in the symmetry of
parametersofwalking pattern appeared first, being a result of lateralization of
discomfort/pain syndrome and behavioral (adaptive) changes of walking pattern. In
the patients with stage II of the disease symmetry of parameters of walking pattern
was found to be lower than in those withstage I due to the addition of compensatory
changes in stance time.
Use of intra-articular infusion of local anesthetic in the patients after hip
arthroscopy significantly decreased both the incidence of evident pain syndrome –
in 13 times (СШ: 0.06; 95% ДІ: [0.007-0.46]), and pain intensity – in 7 times on
an average(р<0.05). This also contributed to decreased average frequency in the use of additional parenteral analgesics by 13.7%, preventing complications and
adverse effects of NSAIDs.
Use of the developed rehabilitation program in the patients after
arthroscopic treatment had such clinically significant effects as increased mobility
according to modified Harris score. Mobility values during three and six months
after hip arthroscopy were significantly higher - by 7.3% (р<0.001) and 5.8%
(р=0.011), respectively, in the group of subjects who followed suggested
recommendations to an extent of 80%, when compared to those who followed the
recommendations to an extent of less than 80%.
Short-term comparison of treatment results after 1, 3 and 6 months of
study was made in two groups of patients. The patients of the treatment group
(n=105) underwent diagnostic and therapeutic hip arthroscopy.
The positive effect of drug therapy was observed during the first three
months of conservative treatment, where as after arthroscopic intervention
improvement of pain syndrome and functional capacity of hip joint was noted in
three months after arthroscopy. But after 6 months of treatment those patients had
significantly lower intensity of pain syndrome (by 19.2%) along with the
improvement of functional mobility of the hip joint on an average by 12.1% in the
period of 3-6 months after the operation, as compared to the patients who received
treatment modifying the course of disease.
Comparison of average values of mobility function of the hip joint at
definite stages of the study revealed significant differences between the treatment
and the control groups in the values of modified Harris score in 1, 3 and 5 years
after the beginning of treatment (р<0.001). According to this scale, the values were
higher by 23.2%, 28.8% and 32.8%, respectively, in the treatment group (in
arthroscopic restoration of joint congruency).
The differences in frequency of patients requiring total hip arthroplasty in
1 year (OR: 0.33; SI: [0.1-1.03], р=0.047), 3 years (OR: 0.33; SI: [0.17-0.65]) and
5 years (OR: 0.43; SI: [0.22-0.82], р=0.009) were established, it being lower
among the patients of the treatment group.
