Uloga hirurških procedura u prevenciji i lečenju osteoartroza kuka nastalih morfološkim promenama vrata butne kosti

Abstract

Introduction: Hip osteoarthrosis is a common disease, it can be primary or secondary. Secondary hip arthrosis can often be the consequence of morphological changes on the femoral neck bone, and it is the cause of femoroacetabular impingement. The pathophysiology of impingement is characterized by premature contact of femoral neck and head joint with frontal or upper frontal edge of acetabulum. Aim of the paper: The analysis of the effect of femoral morphological changes, by the type of bone bump - CAM deformity, to the development of hip joint osteoarthrosis and the justification of surgical treatment of the deformity as a means of prevention. On experimental animals surgically create a morphological change on the femoral neck, CAM deformity type, and determine the form and the degree of the hip joint osteoarthrosis development. Analyze the test subjects who have undergone hip aloarthroplastics due to osteoarthrosis caused by CAM deformity, with heightened focus on the femoral head bone position and size, form and position of the bone bump. Method: This research includes two groups of human test subjects and a group of experimental animals. In one group of test subjects we have monitored clinical and radiological signs caused by CAM deformity, pre and post-operatively. The other group of test subjects includes patients who have been implanted total cementless hip endoprosthesis, due to the secondary hip osteoarthrosis caused by CAM deformity that had not been treated surgically. We have induced iatrogenically a CAM deformity on experimental animals, by placing a metal screw in the femoral head and neck joint of a hare, and then we have histologically monitored the development of secundary arthrosis on the hip – we have monitored the time of its origin and the degree of damage. Results: They have been grouped to demographic, clinical, radiological and histological results. Demographic results deal with the development of femoroacetabular impingement in young people and the need to detect clinically and radiologically morphological deformities of femoral head and neck early and treat them surgically. Postoperative clinical and radiological parameters in this group of test subjects suggest an absolute need and justify surgical treatment. Non-treated morphological deformities lead to an early osteoarthrosis of the hip, which can be solved with an implantation of hip endoprosthesis, ie. the replacement of natural hip joint with an artificial one. Significant differences between preoperative and postoperative values of the tested parameters have been found, which suggests a need for an early detection and surgical treatment of CAM deformities. Experimental results confirm the influence of CAM deformities to cartilage and labrum of the hip joint regarding the development of osteoarthrosis. Conclusion: Through experimental work and collected histological results, we have confirmed the influence of iatrogenic CAM deformity on femoral neck, to the development of Marko D. Mladenović: Uloga hirurških procedura u prevenciji i lečenju osteoartroza kuka nastalih morfološkim promenama vrata butne kosti secondary hip osteoarthrosis. According to the stage of development, it is more present in hares which have long been exposed to the influence of this type of morphological change on the femoral neck. Femoroacetabular impingement needs to be detected early, clinically and radiologically identified, and surgically treated as soon as possible. The results of operative treatment and hip joint durability depend on the degree of cartilage damage at the moment of the surgical treatment. Hip joint osteoarthrosis caused by CAM deformity develops in younger persons after 45 – 55 years of life, and the only solution is the implementation of cementless hip endoprosthesis. It needs to be a prosthesis from the group of short stemmed prostheses, in order to spare femoral metaphysis and save the diaphysis for secondary surgical intervention, ie. reintervention. Considering artificial hip joint implementation, clinical and radiological preoperative planning is necessary.