Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of RussiaТравматология и ортопедия России2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics148910.21823/2311-2905-2020-26-2-180-200ReviewsОбзорыReviewsDislocations after Hip Arthroplasty (Review)Вывихи после эндопротезирования тазобедренного сустава (обзор литературы)SeredaA. P.СередаА. П.
Russian Federation

Andrey P. Sereda — Dr. Sci. (Med.), Deputy Head; Deputy Head, The Center of Innovative Technologies in Traumatology and Orthopedics

Moscow

Середа Андрей Петрович — д-р мед. наук, заместитель руководителя ФМБА России; заместитель директора НОКЦ Инновационных технологий в травматологии и ортопедии

Москва

drsereda@gmail.comSmetaninS. M.СметанинС. М.
Russian Federation

Sergey M. Smetanin — Dr. Sci. (Med.), Orthopedic Surgeon

Moscow

Сметанин Сергей Михайлович — д-р мед. наук, врач травматолог-ортопед

Москва

Federal Medical Biological AgencyФедеральное медико-биологическое агентство РоссииSechenov First Moscow State Medical UniversityФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова Минздрава России (Сеченовский университет)»090720202621802000907202009072020https://journal.rniito.org/jour/article/view/1489

One of hip arthroplasty complications is dislocation of the endoprosthesis head. In the vast majority of cases, the cause of dislocation is multifactorial. That is why only a thorough analysis of the patient’s peculiarities, surgery and rehabilitation will help to avoid the relapse. This review analyzed the risk factors of dislocation and treatment tactics. Risk factors associated with the patient include: old age, male gender, obesity, concomitant diseases, low level of preoperative physical activity, low compliance and a some others. The problem of the biomechanical ratio in the segment “spine – pelvis – lower limb” deserves special attention. Besides, there are risk factors associated with the surgeon: access option; type, fixation and position of endoprosthesis components, experience and surgical technique of a orthopedic surgeon. The strategy of dislocations rate reduction is based on a detailed study of dislocation causes and their elimination, and adequate surgery planning. The treatment of a patient with dislocation should take into account the multifactorial etiology of the condition.

Одним из осложнений артропластики тазобедренного сустава является вывих головки эндопротеза. В подавляющем большинстве случаев причина вывиха многофакторна, и только адекватный анализ особенностей пациента, оперативного пособия и реабилитации поможет избежать его рецидива. Настоящий обзор литературы посвящен факторам риска вывихов и тактике их лечения. Среди факторов риска, связанных с пациентом, выделяют возраст, мужской пол, ожирение, сопутствующие заболевания, низкий уровень предоперационной физической активности, низкий комплайнс и ряд других. Заслуживает отдельного внимания проблема биомеханического соотношения в сегменте «позвоночник – таз – нижняя конечность». Кроме того, есть факторы риска, связанные с хирургом: выбранный доступ; тип, фиксация и положение компонентов эндопротеза; опыт и хирургическая техника ортопеда. Стратегия снижения частоты вывихов основана на детальном изучении причин возникновения, их коррекции, планировании адекватной хирургическое помощи, а лечение пациента с вывихами должно учитывать их мультифакторную этиологию.

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