Peculiarities of Preoperative Planning of Total Hip Arthroplasty in Patients with Hip-Lumbar Syndrome

Summary. At present, no scheme of approach to surgical treatment of patients with hip-lumbar syndrome (HLS) depending on the type of vertical posture and the type of bone formation and progression of coxarthrosis is developed. The decision of these questions, interesting from the scientific and practical point of view, is an actual task of modern orthopedics and defines features of preoperative planning of total hip arthroplasty (THA) in patients with HLS. Objective: to determine the features of preoperative planning of total hip arthroplasty in patients with hip-lumbar syndrome. Materials and Methods. The basis for the development of recommendations for preoperative planning of THA in patients with HLS was the data of retrospective analysis of medical histories of 138 patients who underwent hip arthroplasty in the Department of Orthopedics and Traumatology of Adults of SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine”. The data of the clinical study of 506 patients with idiopathic, dysplastic and post-traumatic coxarthrosis conducted earlier were also taken into account, and the tactics of treatment in cementless hip arthroplasty was developed. Results. It was determined that the vertical posture affects the progression of coxarthrosis and the nature of the lesion of the lumbar spine in patients with HLS. Patients with a certain hypolordotic posture and a rapid course of coxarthrosis are recommended to undergo primary decompression of the spinal roots and THA at the second stage. In other cases, the initial implementation of THA is recommended. Recommendations for the use of the type and method of fixation and coverage of the leg of the endoprosthesis depending on the type of bone formation in the HLS of the examined patients are developed. Conclusions. Taking into account the features of preoperative planning of THA in patients with HLS will reduce the number of negative results and complications of this category of orthopedic patients.

THE ROLE OF DISCOGENOUS RADICULOPATHIES AND SPONDYLOLYSTHESIS IN THE STRUCTURE OF PAIN SYNDROME AFTER TOTAL HIP ARTHROPLASTY

Resume. In the structure of complications, pain syndrome, which is not associated with instability of the components of the endoprosthesis or infection, remains a serious problem due to difficulties in diagnosis and treatment. The cause of residual pain may be the presence in the patient of discogenic radiculopathy or spon-dylolisthesis of the lumbar spine. The aim of the study. To determine the role of discogenic radiculopathies and spondylolisthesis of the lumbar spine in the structure of pain after hip arthroplasty. Materials and methods. A sample and retrospective analysis of case histories of 138 patients with hip and lumbar syndrome, who under-went hip arthroplasty in the clinic of orthopedics and traumatology of adults SI "ITO NAMS of Ukraine". All patients were examined clinically and radiologically. Additionally, all patients were examined by a neurolo-gist to determine the neurological status of patients, diagnosis. Evaluation of the effectiveness of treatment of patients with residual effects of discogenic radiculopathy and spondylolisthesis after hip arthroplasty was performed on the functional scale of Oswestry. Results. The analysis of the patient database revealed a statisti-cally significant (p≤0.05) predominance of patients with the presence of disc herniation at the level of L3-L4 and hypolordosis. The survey revealed 9 cases of discogenic radiculopathy and 6 cases of spondylolisthesis in patients with PD, which amounted to 6.5% and 4.5% of the total number of examined patients. The high effi-ciency of the developed treatment-and-prophylactic measures in patients with discogenic radiculopathy or spondylolisthesis and lumbar-lumbar syndrome has been determined. Timely appointment of complex conserva-tive and operative methods allowed to achieve satisfactory results in 100% of cases. Conclusions. Studies to determine the role of discogenic radiculopathy and spondylolisthesis of the lumbar spine in the structure of pain after hip arthroplasty will contribute to the further development of clinical, diagnostic and treatment algorithms for patients with hip and lumbar syndrome.

FEATURES OF FORMATION OF CONTRACTURES OF A HIP JOINT AT PATIENTS WITH A HIP-LUMBAR SYNDROME

Resume. With significant destructive changes in the hip joints, endoprosthesis is the main method of surgical treatment of coxarthrosis. However, according to the Swedish and Canadian registries, 17-20% of patients have pain after arthroplasty. The cause of residual pain may be a concomitant lesion of the spine, and the study of issues related to the clinical features of the hip-lumbar syndrome are relevant from a scientific and practical point of view. The purpose of the study: to analyze the clinical and radiological picture of patients with coxarthrosis with concomitant pathology of the spine, to investigate the dependence of the severity of flexion contracture of the hip, variable parameters (pelvic angle RT and lumbar lordosis GLL) from constant angle and angle; to study the features of the clinical course of hip-lumbar syndrome. Materials and methods. An analysis of the results of examination of 150 patients with stage III-IV idiopathic coxarthrosis who under-went hip arthroplasty in the clinic of orthopedics and traumatology of adults of the State Institution "ITO NAMS of Ukraine" was performed. Hip pain and functional impairment were assessed according Harris and Womac scales also before hip arthroplasty and 3 months after surgery. Results. Analysis of the obtained data shows that with an increase in the angle of inclination of the pelvis and flexion contracture, the values of the parameters of the angle of pelvic deviation increase, which causes a statistically significant increase in the angle of lumbar lordosis. The correlation coefficients between the parameters PI-PT and PI-GLL were 0.65±0.15 and 0.74±0.11, respectively. Conclusions. Pain in patients with small contracture of the hip joint is associated with neuro-dystrophic syndrome in osteochondrosis of the lumbar spine, in patients with larger contracture - with spondyloarthritis. In the vertical position of the sacrum - GLL - the smallest, least pro-nounced and flexion contracture of the hip joint. On the contrary, in the horizontal position of the sacrum in patients with hyperlordosis and significant, more than 10 ° contracture in the hip joints.

Determination of dependence of coxartrosis progression form on vertical posture option patients hip-lumbar syndrome

Summary. A retrospective analysis of case histories and radiographs of 138 patients with hip-lumbar syndrome who underwent hip joint replacement in the clinic of orthopedics and adult traumatology at the ITO NAMS of Ukraine was carried out. It has been determined that the variant of vertical posture, acting on the morphogenesis of coxarthrosis, determines the rate of its progression. It was determined that in the presence of hip-lumbar syndrome, a moderate form of CA progression most often occurs, regardless of the type of lordosis. The slow rate of progression of coxarthrosis is characteristic of hyper- and normolordosis. Hypolordosis is statistically significant (p < 0,05) characterized by a faster course of the pathological process in the hip joint than other types of lordosis. The studies will contribute to the further development of the clinical diagnostic and therapeutic algorithm for patients with hip-lumbar syndrome.

The Role of Spondyloarthrosis in the Structure of Pain After Hip Arthroplasty

Summary. In the structure of complications, pain syndrome, which is not associated with infection or instability of the components of the endoprosthesis, remains a serious problem due to the difficulties of diagnosis and treatment. The cause of the residual pain may be the presence of spondyloarthrosis of the lumbar spine in the patient. Objective: to determine the role of spondyloarthrosis of the lumbar spine in the structure of pain after hip arthroplasty. Materials and Methods. A sample and retrospective analysis of the case histories of 138 patients with hip-lumbar syndrome who underwent hip arthroplasty in the Department of Traumatology and Orthopedics of Adults of the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine” was carried out. All patients were examined clinically and radiographically. Additionally, all patients were examined by a neurologist with the determination of the neurological status and diagnosis. Evaluation of the effectiveness of hip arthroplasty in order to improve the clinical and functional characteristics of the link hip joint – spine was carried out according to the Haris and Oswestry functional scales. Results. The analysis of the database of patients in them proved that the lumbar vertebrae at the L2-L4 level are more often affected. In hyperlordosis, degenerative lesions occur in the posterior column of the lumbar spine in the form of spondyloarthrosis, which is clinically manifested by lumbodynia; with hypolordosis, the anterior column suffers more, which is clinically manifested by the presence of lumboishalgia. Total arthroplasty of patients with hip-lumbar syndrome contributes to statistically significant (p≤0.05) reduction in pain syndrome and improvement of function both in the hip joint and the lower back. Residual, less intense, pain syndrome after arthroplasty was most intensive in patients with hypolordosis (24.11 points according to Oswestry’s classification). Сonclusions. The studies carried out to determine the role of spondyloarthrosis of the lumbar spine in the structure of pain after hip arthroplasty will contribute to the further development of a clinical diagnostic and therapeutic algorithm for patients with hip-lumbar syndrome.

Pharmacoeconomic Aspects of Low Back Pain Treatment: Cost of Illness Study in the Republic of Serbia

Introduction: Chronic diseases with disabilities have a huge pharmacoeconomic impact on the health budget, especially in countries with recent history of social and economic transition. The aim of this study was to identify total costs of treating patients with lumbar pain in medical facilities in the central part of the Republic of Serbia.Material and Methods: This study was designed as a cost of illness study, using a bottom-up approach and it was conducted from a societal perspective. This study included 97 patients with lumbar syndrome who were treated in outpatient facilities in the Central part of Serbia.Results: Total costs of treating lumbar pain were about €200.40 ± €86.65 per patient per year, where the largest volume of direct costs were costs due to visits to specialists in primary health care institutions (€9.39 ± €6.66). Total indirect costs were €182.00 ± €78.66.Discussion: Our findings highlight the need to estimate the total costs of treating lumbar pain and evaluate the correlation between costs and other variables for larger population of these patients.Conclusion: This study distinguished two important pharmacoeconomic aspects of treating lumbar pain. Firstly, indirect costs represent major part of total costs of treating lumbar syndrome. Secondly, differences in valuing medical services between countries with recent history of social and economic transition and countries within European Union are one of crucial reasons for difference in total costs of treating low back pain among patients in neighboring regions.

Validation of the Scale Intended for the Assessment of the Quality of Life of Persons With Lumbal Syndrome // Validacija skale namenjene proceni kvaliteta života osoba sa lumbalnim sindromom

In order to determine the metric characteristics of the scale intended for the assessment of the quality of life of persons with lumbar syndrome (PQL-LS) on a sample of 202 subjects (M = 93; F = 109), three procedures for checking its metric characteristics were applied: factor analysis (Principal Components Analysis) with the Direct Oblimin method, in order to identify the latent structure of the perception of the quality of life of the respondents; Scale Reliability Analysis based on Cronbach’s alpha coefficient; and a validation check based on the coefficient of internal correlation of the scale (Spearman’s correlation of rank - rho). The results show that the scale has good metric characteristics and that it has a multi-item character (twenty-seven indicators). The internal accordance of the scale is in the high reference range of the Cronbach’s alpha coefficient (0.947). The values of correlation coefficient of subscale scores: physical health, mental health, social relations and environment show a high degree of correlation with the overall mean value of the entire scale, which confirms the validity of the analyzed domains (subscale) and the scale as a whole (at the level of significance r <0.001). All 27 variables yielded the corresponding weight of the single extracted component (KMO = 0.901; Sig. = 0.000), which determined that the scale had adequate validity. Based on the identified good metric characteristics, this scale can be recommended for use as a unique/autonomous multi-item scale designed to assess the quality of life of adults with lumbar syndrome.