Efikasnost ugradnje totalne bescemenetne endoproteze kuka nakon osteotomije ilijačne kosti metodom po Chiari-ju

Abstract

Nepotpuna natkrovljenost glave butne kosti se karakteriše poremećenim anatomskim odnosima u zglobu kuka i predstavlja stanje između pozicija apsolutne podudarnosti i potpunog odsustva kontakta dveju zglobnih površina. U mlađoj životnoj dobi najčešće je asimptomatska i predstavlja uzgredan radiografski nalaz. Osteotomija ilijačne kosti po Chiari-ju predstavlja jednu od takozvanih osteotomija “spasavanja“ koje imaju za cilj smanjivanje tegoba, pre svega bola, kod pacijenata sa nepopravljivo narušenim oblikom zglobnih površina. Bila je veoma rasprostranjena i često korišćena metoda u lečenju razvojnog poremećaja kuka i drugih ortopedskih stanja praćenih nepotpunom natkrovljenošću glave butne kosti. Kod velikog broja takvih pacijenata vremenom su se razvile degenerativne promene koje zahtevaju nove hirurške intervencije, pre svega zamenu zgloba veštačkim. Aloartroplastične hirurške procedure su kod pacijenata sa značajno izmenjenim anatomskim odnosima u zglobu kuka izuzetno složene i nepredvidljive, a broj intraoperativnih komplikacija i kasnijih reintervencija nije zanemarljiv. CILJEVI • Utvrditi i uporediti funkcionalni status nakon ugradnje totalne bescementne endoproteze kuka u grupi pacijenta kod kojih je prethodno učinjena osteotomija ilijačne kosti metodom po Chiari-ju u odnosu na grupu pacijenata kod kojih takva procedura nije učinjena, iako je postojala indikacija; • Dokazati opravdanost osteotomije ilijačne kosti metodom po Chiari-ju u smislu očuvanja funkcije zgloba kuka i odlaganja daljih hirurških procedura, pre svega ugradnje veštačkog zgloba; • Ustanoviti tehničke poteškoće prilikom ugradnje i definisati najčešće komplikacije nakon ugradnje totalne bescementne endoproteze kuka kod pacijenata prethodno operisanih metodom po Chiari-ju; • Uporediti radiografske parametre totalne endoproteze kuka između dve grupe ispitivanih pacijenata radi procene trajnosti implantata...

Insufficient femoral head coverage is characterized by altered anatomic hip correlations. It represents condition between absolute joint congruency and complete absence of contact between the two joint surfaces. In the younger age group is usually asymptomatic and an incidental radiographic finding. Chiari surgery is one of so-called „salvage“ osteotomies aimed at reducing symptoms, especially pain, in patients with insufficient femoral head coverage when a full reconstruction of anatomic correlations cannot be expected even by utilization of other more efficient and technically more challenging pelvic osteotomies. It was very frequently used method in the treatment of developmental dysplasia of the hip and other orthopedic conditions followed by insufficient femoral head coverage. A large number of such patients eventually have developed degenerative changes that require a new surgical procedure, primarily total hip replacement. Total hip arthroplasty in patients with significantly altered anatomic correlations in the hip joint is extremely complex and unpredictable, and the number of intraoperative complications and subsequent reinterventions is not negligible. OBJECTIVES • Identify and compare the functional status after implantation of noncemented total hip endoprosthesis in a group of patients who had previous Chiari osteotomy in relation to the group of patients in whom this procedure was not performed, although there was an indication; • Prove justification of Chiari pelvic osteotomy in terms of preserving the function of the hip joint and delay of further surgical procedures, primarily the total hip arthroplasty • Establish technical difficulties during total hip arthroplasty and define the most common complications after implantation of noncemented total hip endoprosthesis in patients previously operated on by the Chiari method; • Compare radiographic parameters of total hip replacement between the two groups of patients to assess the durability of the implant...