Vol 32, No 2 (2026)

Background. Outcomes of arthroscopic treatment for femoroacetabular impingement (FAI) remain variable. The most debated aspects include the type of capsulotomy, the method of acetabular labrum refixation, and the accuracy of cam deformity correction. The influence of different technical options at the key stages of hip arthroscopy on morphological and clinical outcomes in patients with FAI remains insufficiently studied.

The aim of the study — to compare morphological and clinical outcomes of arthroscopic treatment in patients with femoroacetabular impingement managed with standard versus modified surgical strategy.

Methods. A single-center comparative cohort study included 88 patients who underwent 94 hip arthroscopic procedures. The retrospective group comprised 61 patients (64 hips), the prospective group — 27 patients (30 hips). The modified strategy included longitudinal capsulotomy with capsular closure, avoidance of knotted acetabular labral anchors, and a modified method of preoperative planning and intraoperative execution of cam deformity correction. Clinical outcomes were assessed preoperatively and at 12 months postoperatively using the iHOT-33, HOS-ADL, and HOS-Sport. Morphological outcomes were evaluated using Dunn 45° X-rays and follow-up magnetic resonance imaging.

Results. Before surgery, the groups did not differ in most demographic, clinical, and radiographic characteristics; the only statistically significant baseline difference was found for HOS-ADL. Postoperatively, the prospective group demonstrated a higher iHOT-33 score than the retrospective group (90.4 [81.3; 96.2] vs 80.4 [71.8; 90.8] points; p = 0.002), while score improvement was greater for iHOT-33 (38.3 [29.3; 50.3] vs 23.5 [10.3; 39.5] points; p = 0.003), HOS-ADL (32.5 [13.2; 42.6] vs 11.8 [5.5; 23.2] points; p = 0.005), and HOS-Sport (37.5 [25.0; 53.5] vs 20.8 [5.6; 45.1] points; p = 0.038). The rate of achieving substantial clinical benefit for iHOT-33 was higher in the prospective group: 26/30 (86.7%; 95% CI 69.3-96.2) vs 28/64 (43.8%; 95% CI 31.4-56.7); p < 0.001. The modified strategy was associated with a lower postoperative alpha angle, a higher femoral head-neck offset ratio, a higher rate of spherical femoroplasty, more frequent complete capsular healing on MRI, and a lower rate of anchor-related MRI changes in analyses by anchor type.

Conclusion. The use of a modified arthroscopic strategy in patients with femoroacetabular impingement was associated with more favorable morphological and clinical outcomes compared with the standard approach. In reduced multivariable models, non-intact capsular status demonstrated the most stable association with smaller improvement in clinical rating scale scores and failure to achieve clinically meaningful thresholds.

Background. Traditionally, single-stage revision arthroplasty was recommended only for a very limited cohort of patients. However, in the last decade, a global trend towards expanding the indications for this surgical option can be observed. The need to reduce the hospital costs for the treatment of periprosthetic joint infection (PJI) often leads to the shortening of preoperative period by refusing to wait for the results of microbiological investigation (MBI).

The aim of the study — to evaluate the effectiveness of single-stage revision arthroplasty in patients with chronic periprosthetic hip infection, depending on the presence or absence of relative contraindications to this procedure.

Methods. The study included 40 patients with chronic hip PJI who underwent surgical treatment between January 2022 and May 2024. After obtaining biomaterials (aspiration and/or tissue biopsies), preliminary MBI results were awaited within 5 days. After that, the patients were allocated into two groups. Group 1 included patients in whom a single strain of Gram-positive bacteria was isolated, Group 2 — patients in whom no pathogen growth was detected, or in whom polymicrobial associations or Gram-negative bacterial strains were identified. In Group 1, surgery was performed only after the final MBI results were available, whereas in Group 2, the final results were not awaited. All patients underwent single-stage revision arthroplasty, and local antibacterial therapy was performed within 3 days after surgery. The follow-up period for the cohort was no less than 24 months.

Results. Periprosthetic joint infection was successfully managed in 97.5% of cases (n = 39). The following relative contraindications to single-stage revision arthroplasty were identified: data on the pathogen and its antibiotic susceptibility were unavailable at the time of surgery in 67.5% of patients, 37.5% had a functioning fistulous tract, 27.5% had recurrent PJI, and 5% — massive acetabular defects (Paprosky type 3B) along with multiple prior debridement procedures. No impaired kidney function, adverse local or systemic reactions were observed during local antibacterial therapy.

Conclusions. With effective local antibacterial therapy, the indications for single-stage revision arthroplasty can be expanded, and the procedure can be successfully performed — even in the absence of data on the causative pathogen at the time of surgery. However, the following conditions remain essential for performing a single-stage procedure: absence of severe comorbidities, as well as extensive soft-tissue and/or bone defects, and the feasibility of administering local therapy in the early postoperative period along with prolonged systemic oral antibiotic therapy.

Background. Currently, there are no generally accepted methods for predicting failure of proximal femoral fracture (PFF)surgery.

The aim of the study — to develop a model for predicting orthopedic complications within a year after surgical treatment of proximal femoral fractures and evaluate its effectiveness.

Methods. A retrospective study was conducted on the treatment outcomes of 850 patients who underwent surgical treatment for PFF using various osteosynthesis techniques. The average patient age was 73.6±13.3 years; the male to female ratio — 1:3 (211 and 639, respectively). The follow-up period was 12 months. All risk factors identified in the study were assessed as yes/no events.

Results. The overall annual incidence of orthopedic complications was 21.65%. The orthopedic complication risk factor calculator included 10 parameters: patient age, sex, body mass index, Charlson comorbidity index, cortical index, preoperative length of hospital stay, as well as laboratory parameters (hemoglobin, total protein, leukocytes) upon admission, along with the clinical classification of the diagnosis according to ICD-10. Internal and external validation of the calculator was conducted.

Conclusion. The developed calculator allows for the assessment of risk factors for orthopedic complications within a year after surgical treatment of proximal femoral fractures with an accuracy of 86.4%, a sensitivity of 65.7%, and a specificity of 90.2%.

Background. Long bone nonunions of the limbs are considered one of the most serious complications in traumatology and orthopedics, significantly influencing the social aspects of the injured patients’ later lives. Patients report pain at the nonunion site, inability to bear axial load on the affected limb, and decreased social activity and quality of life. The main causes of long bone nonunions are impaired blood supply to the limb segment due to soft tissue injury, inadequate fixation of bone fragments, infectious complications, poor bone quality, and the presence of somatic comorbidity.

The aim of the study — to evaluate the effectiveness of gene-activated osteoplastic material in managing patients with extra-articular nonunions of the distal femur.

Methods. A prospective single-center nonrandomized cohort clinical trial was performed. The study included 64 patients who underwent elective surgical interventions for extra-articular nonunions of the distal femur between 2020 and 2024. The patients were divided into two groups. Group 1 (control, n = 31) underwent re-fixation of the bone with a plate supplemented by autologous bone grafting. Group 2 (main, n = 33) underwent re-fixation of the bone with a plate combined with grafting using a gene-activated osteoplastic material ‘‘Histograft’’. Outcomes following surgical treatment of patients with extra-articular distal femoral nonunions (ULBNC types NU33A31, NU33A32, and NUSS class 3, 51-75 points) were analyzed. Union and the state (remodeling, resorption) of the gene-activated material were evaluated according to the data of postoperative radiological examinations of the operated limb using the REBORNE scoring system. Preoperative and follow-up questionnaires (at 3, 6, 12, and 18 months) were administered to all patients according to the international scales NRS, LEFS, REBORNE, and SF-36.

Results. Throughout the postoperative follow-up period, patients treated with our proposed technique were more satisfied with the outcomes of reconstructive interventions than those in the standard surgical treatment group. The main group showed better anatomical and functional outcomes, as evidenced by the REBORNE score at 6 months: 8.94±0.67 points in the comparison group versus 12.57±2.24 points in the main group (p < 0.001). The overall complica-tion rate was 25.8% (8 cases) in the control group, compared to a statistically significantly lower rate of 6.1% (2 cases) in the main group (p = 0.03).

Conclusion. The proposed technique of combined use of a gene-activated osteoplastic material together with an autologous bone graft has improved the treatment outcomes in patients with extra-articular nonunions of the distal femur by reducing consolidation time, intraoperative blood loss and lowering the rates of complications, reoperations, and pain syndrome.

Background. Plantar fasciitis (PF) is one of the most common degenerative inflammatory diseases of the foot, often accompanied by chronic pain and decreased quality of life. Low-dose radiation therapy (LDRT) is considered a potentially effective treatment option for refractory forms of the disease; however, data on its application using modern radiation techniques remain limited.

The aim of the study — to evaluate the efficacy of low-dose radiation therapy in patients with chronic plantar fasciitis who failed standard conservative treatments.

Methods. A prospective case series study was performed. The study included 32 patients over 40 years of age with a diagnosis of plantar fasciitis (ICD-10 code M77.3), confirmed clinically and/or radiographically, and a pain duration of ≥ 3 months. All patients had previously received at least two types of conservative treatment (massage, therapeutic exercise, extracorporeal shock wave therapy, local corticosteroid injections, laser therapy, orthoses, and orthotic insoles) without clinically significant improvement. Patients were allocated to groups according to the technique used: 26 received LDRT using a direct electron beam from a linear accelerator (linac); 5 — photon therapy using VMAT (volumetric modulated arc therapy, a form of IMRT) delivered via linac; and one with Co-60 gamma therapy. LDRT was administered at a dose rate of 0.5 Gy up to a total dose of 3 Gy over 6 sessions. They were administered three times per week on alternate days. Efficacy assessment included changes in pain using the Visual Analogue Scale (VAS) and functional indicators of foot mobility. We evaluated treatment tolerability descriptively by recording early and late radiation reactions, with no systematic safety assessment.

Results. The average pain severity on the VAS decreased from a baseline of 6.0 [5; 7] to 3.5 [2; 4] points at the end of the course and 0.5 points after 6 months (p < 0.001). A significant therapeutic effect was observed in patients with significant baseline limitation of foot mobility (n = 17), with complete or almost complete restoration of function observed in 77.7% of patients (n = 14). Patients with mild baseline limitation of foot mobility (n = 7) noted improvement in foot function in 86.7% of cases (n = 6). No adverse radiation reactions were recorded.

Conclusion. Low-dose radiation therapy has demonstrated high clinical efficacy and a favorable safety profile in patients with chronic plantar fasciitis refractory to conservative therapy. The use of modern dose delivery techniques confirms the feasibility of this approach. Further randomized studies are needed to refine optimal radiation regimens and patient selection criteria.

Background. Flexible flatfoot with Achilles tendon shortening (FFATS) and flexible pes planovalgus (FPPV) are clinically heterogeneous forms of pediatric flatfoot. Conventional diagnostic methods are insufficiently sensitive to changes in the mechanical properties of the soft tissues of the triceps surae muscle and Achilles tendon, which complicates differential diagnosis and treatment personalization.

The aim of the study ― to compare the elastographic parameters of the triceps surae muscle and Achilles tendon in children with flexible flatfoot with Achilles tendon shortening and flexible pes planovalgus using shear wave ultrasound elastography.

Methods. This prospective cohort study included 222 children: 118 with FFATS and 104 with FPPV. A standardized shear wave elastography protocol was used to assess tissue stiffness in the medial and lateral heads of the gastrocnemius muscle, the soleus muscle, the myotendinous junction, and the Achilles tendon.

Results. Children with FFATS demonstrated statistically significantly higher stiffness values of the soleus muscle, medial head of the gastrocnemius muscle, and Achilles tendon, as well as reduced stiffness of the myotendinous junction. The stiffness of the medial head positively correlated with pain (ρ = 0.54; p < 0.001) and negatively correlated with dorsiflexion (ρ = –0.60; p < 0.001).

Conclusion. A characteristic stiffness profile of the triceps surae muscle and Achilles tendon was identified in children with flexible flatfoot with Achilles tendon shortening compared with children with flexible pes planovalgus. Children with flexible flatfoot with Achilles tendon shortening demonstrated higher stiffness values of the soleus muscle, medial head of the gastrocnemius muscle, and Achilles tendon, along with reduced stiffness of the myotendinous junction. These findings may serve as a basis for further investigation into the pathogenesis of different forms of pediatric flatfoot and for substantiating a differentiated approach to their treatment.

Background. High-quality evidence-based studies have led orthopedic surgeons to abandon lavage and debridement in patients with knee osteoarthritis (OA). However, the issue of the advisability of arthroscopic partial meniscectomy in such patients remains unresolved, which explains the continued high number of such procedures worldwide.

The aim of the review — to compare the data from current randomized clinical trials on the efficacy and indications for arthroscopic partial meniscectomy for degenerative meniscal tears in patients with knee osteoarthritis with recent clinical guidelines.

Methods. A literature search for publications from 2014 onward was performed in domestic and international databases, including eLIBRARY, CyberLeninka, PubMed, Scopus, and Wanfang. A total of 9 publications were selected for analysis (5 randomized controlled trials, 3 meta-analyses, and 1 cohort study), along with 9 current clinical guidelines from leading professional societies regarding partial meniscectomy in patients with knee OA.

Results. The majority of publications included in this review report no significant differences in clinical outcomes between arthroscopic treatment and conservative therapy beyond 12 months. Any positive effect, if present, lasts only from 6 to 12 months. However, among the current clinical guidelines presented in the review, nearly half (48%) still recommend this procedure.

Conclusion. Recent high-quality evidence-based studies on arthroscopic partial meniscectomy for degenerative meniscal tears in early knee osteoarthritis demonstrate no sustained clinical benefit compared to nonoperative treatment. This should be considered during the next revision of current clinical guidelines.

The clinical guidelines describe modern approaches to the prevention, diagnosis, and treatment of infections associated with orthopedic implants. The clinical guidelines are intended for physicians of various specialties providing medical care to relevant patients: orthopedic and trauma surgeons, anesthesiologists and critical care physicians, clinical pharmacologists, healthcare administrators, as well as medical students, residents, and postgraduates.

This publication presents the key provisions of the clinical guidelines, the full text of which can be found on the website cr.minzdrav.gov.ru.