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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">jkto</journal-id><journal-title-group><journal-title xml:lang="ru">Кафедра травматологии и ортопедии</journal-title><trans-title-group xml:lang="en"><trans-title>Department of Traumatology and Orthopaedics</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2226-2016</issn><publisher><publisher-name>ПРОФИЛЬ — 2С</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.17238/2226-2016-2024-3-41-55</article-id><article-id custom-type="elpub" pub-id-type="custom">jkto-75</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>КЛИНИЧЕСКИЙ СЛУЧАЙ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>CLINICAL CASE</subject></subj-group></article-categories><title-group><article-title>Нестандартный клинический случай: 13-летний путь от первичного эндопротезирования тазобедренного сустава до индивидуального 3D компонента</article-title><trans-title-group xml:lang="en"><trans-title>Non-standard clinical case: a 13-year journey from primary hip replacement to a custom 3D implant</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5753-8926</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Мурылев</surname><given-names>В. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Murilev</surname><given-names>V. Y.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Мурылев Валерий Юрьевич — д-р мед. наук, профессор кафедры травматологии, ортопедии и хирургии катастроф, ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский университет) Минздрава России; заведующий Московским городским центром эндопротезирования на базе ГБУЗ ММНКЦ Боткинская больница ДЗ г. Москвы.</p><p>Ул Трубецкая, д. 8. стр. 2 119991, Москва; 2-й Боткинский п-зд, д.5. 125284, Москва</p></bio><bio xml:lang="en"><p>I nf o r m a t io n a b o u t t h e a u t h o r s:</p><p>Valery Yu. Murylev — Dr. Sci (Med.), Professor, Department of Traumatology, Orthopaedic and Disaster Surgery, Sechenov First MSMU; Head of Moscow City Arthroplasty Centre, Botkin MCH.</p><p>Moscow</p></bio><email xlink:type="simple">nmuril@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0217-2434</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Елизаров</surname><given-names>П. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Elizarov</surname><given-names>P. M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Елизаров Павел Михайлович — канд. мед. наук, доцент кафедры травматологии, ортопедии и хирургии катастроф, ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский университет) Минздрава России; врач травматолог-ортопед, ГБУЗ ММНКЦ Боткинская больница ДЗ г. Москвы,</p><p>Ул Трубецкая, д. 8. стр. 2 119991, Москва; 2-й Боткинский п-зд, д.5. 125284, Москва</p></bio><bio xml:lang="en"><p>Pavel M. Elizarov — Cand. Sci. (Med.), Assistant Professor, Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First MSMU; Orthopaediс Surgeon, Botkin MCH.</p><p>Moscow</p></bio><email xlink:type="simple">elizarov_07@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-6700-0222</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Куковенко</surname><given-names>Г. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Kukovenko</surname><given-names>G. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Куковенко Григорий Андреевич — канд. мед. наук, доцент кафедры безопасности жизнедеятельности и медицины катастроф, ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский университет) Минздрава России; врач травматолог-ортопед, ГБУЗ ММНКЦ Боткинская больница ДЗ г. Москвы.</p><p>Ул Трубецкая, д. 8. стр. 2 119991, Москва; 2-й Боткинский п-зд, д.5. 125284, Москва</p></bio><bio xml:lang="en"><p>Grigory A. Kukovenko — Cand. Sci. (Med.), Assistant Professor, Department of Life Safety and Disaster Medicine, Sechenov First MSMU; Orthopaediс Surgeon, Botkin MCH.</p><p>Moscow</p></bio><email xlink:type="simple">gkukovenko@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3933-672X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Музыченков</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Muzichenkov</surname><given-names>A. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Музыченков Алексей Владимирович — канд. мед. наук, ассистент кафедры травматологии, ортопедии и хирургии катастроф, ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский университет) Минздрава России; врач травматолог-ортопед, ГБУЗ ММНКЦ Боткинская больница ДЗ г. Москвы.</p><p>Ул Трубецкая, д. 8. стр. 2 119991, Москва; 2-й Боткинский п-зд, д.5. 125284, Москва</p></bio><bio xml:lang="en"><p>Aleksey V. Muzychenkov — Cand. Sci. (Med.), Assistant Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First MSMU; Orthopaediс Surgeon, Botkin MCH.</p><p>Moscow</p></bio><email xlink:type="simple">amuzychenkov@inbox.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7599-7472</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Алексеев</surname><given-names>С. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Alekseev</surname><given-names>С. С.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Алексеев Семен Сергеевич — канд. мед. наук, врач травматолог-ортопед.</p><p>2-й Боткинский п-зд, д.5. 125284, Москва</p></bio><bio xml:lang="en"><p>Semen S. Alekseev — Orthopaediс Surgeon, MCH.</p><p>Moscow</p></bio><email xlink:type="simple">semen.alekseev.92@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4811-5718</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Елизаров</surname><given-names>М. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Elizarov</surname><given-names>M. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Елизаров Михаил Павлович — канд. мед. наук, доцент кафедры травматологии, ортопедии и хирургии катастроф.</p><p>Ул Трубецкая, д. 8. стр. 2 119991, Москва</p></bio><bio xml:lang="en"><p>Mikhail P. Elizarov — Cand. Sci. (Med.), Assistant Professor, Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First MSMU.</p><p>Moscow</p></bio><email xlink:type="simple">elizarovm07@gmail.com</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Бобров</surname><given-names>Д. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Bobrov</surname><given-names>D. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Бобров Дмитрий Сергеевич — канд. мед. наук, доцент кафедры травматологии, ортопедии и хирургии катастроф.</p><p>Ул Трубецкая, д. 8. стр. 2 119991, Москва; 2-й Боткинский п-зд, д.5. 125284, Москва</p></bio><bio xml:lang="en"><p>Dmitrii S. Bobrov — Cand. Sci. (Med.), Assistant Professor, Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First MSMU; Orthopaediс Surgeon, Botkin MCH.</p><p>Moscow</p></bio><email xlink:type="simple">dr.bobroff@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4490-2922</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Руднев</surname><given-names>А. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Rudnev</surname><given-names>A. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Руднев Александр Игоревич — ассистент кафедры безопасности жизнедеятельности и медицины катастроф, ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский университет) Минздрава России; врач травматолог-ортопед, ГБУЗ ММНКЦ Боткинская больница ДЗ г. Москвы.</p><p>Ул Трубецкая, д. 8. стр. 2 119991, Москва; 2-й Боткинский п-зд, д.5. 125284, Москва</p></bio><bio xml:lang="en"><p>Aleksander I. Rudnev — Assistant Professor, Department of Life Safety and Disaster Medicine, Sechenov First MSMU; Orthopaediс Surgeon, Botkin MCH.</p><p>Moscow</p></bio><email xlink:type="simple">ruda310895@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0008-8558-7643</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Яковлев</surname><given-names>К. Г.</given-names></name><name name-style="western" xml:lang="en"><surname>Yakovlev</surname><given-names>K. G.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Яковлев Константин Гарриевич — врач, аспирант кафедры травматологии, ортопедии и хирургии катастроф ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский университет) Минздрава России, врач травматолог ГБУЗ ММНКЦ Боткинская больница ДЗ г. Москвы.</p><p>Ул Трубецкая, д. 8. стр. 2 119991, Москва; 2-й Боткинский п-зд, д.5. 125284, Москва</p></bio><bio xml:lang="en"><p>Konstantin G.Yakovlev — Assistant Professor of Botkin City Hospital.</p><p>Moscow</p></bio><email xlink:type="simple">Konstantinyakovlev2503@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет) Минздрава России; ГБУЗ ММНКЦ Боткинская больница ДЗМ г. Москвы</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First Moscow State Medical University; Orthopaediс Surgeon, Botkin Moscow City Hospital; Orthopaediс Surgeon, Botkin Moscow City Hospital</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ГБУЗ ММНКЦ Боткинская больница ДЗМ г. Москвы</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Orthopaediс Surgeon, Botkin Moscow City Hospital</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>ФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет) Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov First Moscow State Medical University; Orthopaediс Surgeon, Botkin Moscow City Hospital</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2024</year></pub-date><pub-date pub-type="epub"><day>13</day><month>03</month><year>2026</year></pub-date><volume>0</volume><issue>3</issue><fpage>41</fpage><lpage>55</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Мурылев В.Ю., Елизаров П.М., Куковенко Г.А., Музыченков А.В., Алексеев С.С., Елизаров М.П., Бобров Д.С., Руднев А.И., Яковлев К.Г., 2026</copyright-statement><copyright-year>2026</copyright-year><copyright-holder xml:lang="ru">Мурылев В.Ю., Елизаров П.М., Куковенко Г.А., Музыченков А.В., Алексеев С.С., Елизаров М.П., Бобров Д.С., Руднев А.И., Яковлев К.Г.</copyright-holder><copyright-holder xml:lang="en">Murilev V.Y., Elizarov P.M., Kukovenko G.A., Muzichenkov A.V., Alekseev С.С., Elizarov M.P., Bobrov D.S., Rudnev A.I., Yakovlev K.G.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.jkto.moscow/jour/article/view/75">https://www.jkto.moscow/jour/article/view/75</self-uri><abstract><p>Уникальность клинического случая заключается в пролонгированном динамическом 13-летнем наблюдении за пациенткой с тотальным эндопротезированием тазобедренного сустава (ТЭТС), перенесшей после эндопротезирования целую палитру хирургических вмешательств и осложнений. Перенесла, различные варианты остеосинтезов, переломы установленных имплантов и их вывихи, перипротезную инфекцию, установку спейсера. В результате многочисленных операций у пациентки сформировался значительный костный дефект в нижней трети бедренной кости. Как возможный эффективный вариант его восполнени, применена 3D персонифицированная ножка ревизионного эндопротеза, имеющая на своем протяжении чередующиеся участки полированного и ребристо-пористого покрытия.</p><sec><title>Описание случая</title><p>Описание случая: Пациентка возраста 64-х лет, через 2 года после эндопротезирования правого тазобедренного сустава получила перипротезный перелом бедренной кости (Vancouver типа «C») с последующим остеосинтезом перелома пластиной и тросами. При падении, в дальнейшем, произошел перелом правого бедра и фиксирующей пластины, при стабильном вертлужном компоненте установленного эндопротеза. Выполнен остеосинтез пластиной NCB, замена ножки на Wagner Rev.SL, замена трибологической пары. Через 2 года пациентке выполнено удаление нестабильной NCB пластины, на фоне сросшегося перелома бедра. Через 3 года-септическое расшатывание ножки эндопротеза с ее удалением и установкой 3D спейсера, с последующим его вывихом на фоне несоблюдения двигательного режима на фоне сформировавшегося грубого дефицита мягких тканей, стабилизирующих тазобедренный сустав. После купирования инфекции больной была изготовлена 3D персонифицированная ножка для ревизионного вмешательства. В ходе предоперационной подготовки у больной возникает перелом спейсера. Итоговое оперативное лечение: за одну операционную сессию удален сломанный спейсер, установлено антипротрузионное кольцо с чашкой системы двойной мобильности Avantage, персонифицированный 3D имплант ножки эндопротеза, пластина NCB, тросы Cable Ready. В нижних отделах ножка фиксирована в канале бедра при помощи костного цемента. В верхних отделах ножки-остеоинтеграция с костью. Данная методика позволила армировать бедренную кость интрамедуллярно, заполнить имеющийся костный дефицит в дистальной метаэпифизарной зоне, восстановить амплитуду движений в суставе минимизируя риски вывихов двойной мобильностью, придать опороспособность конечности. Продолжительность наблюдения за пациенткой составила более 13 лет.</p></sec><sec><title>Заключение</title><p>Заключение: Представленный клинический случай иллюстрирует один из методов возможного персонифицированного подхода к восполнению создавшегося дефицита костной ткани в дистальной метаэпифизарной зоне, возникшего в результате перенесенных многократных оперативных вмешательств на тазобедренном суставе, связанных с коксартрозом и эндопротезированием.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>Relevance</title><p>Relevance: The uniqueness of the clinical case lies in the prolonged dynamic 13-year observation of a patient with THA who, after endoprosthetics, underwent a whole range of surgical interventions and complications. She suffered various types of osteosynthesis, fractures of installed implants and their dislocations, periprosthetic infection, and installation of a spacer. As a result of numerous operations, the patient developed a pronounced deficiency of bone tissue in the lower third of the operated hip with a significant bone defect. As a possible effective option for its replenishment, a 3D personalized revision endoprosthesis leg with a partial bone mantle was used.</p></sec><sec><title>Case description</title><p>Case description: A 64-year-old female patient, 2 years after THA of the right hip joint, with good clinical and radiological results, received a Vancouver type “C” periprosthetic fracture followed by osteosynthesis of the femoral fracture with a plate and Cable Ready cables. The fall subsequently resulted in a fracture of the right femur and the fixation plate, with a stable cup of the installed endoprosthesis. Osteosynthesis was performed with an NCB plate, the stem was replaced with a Wagner Rev.SL, and the tribological pair was replaced. After 2 years, removal of the unstable NCB plate due to a healed hip fracture. After 3 years, there was septic loosening of the endoprosthesis leg with its removal and installation of a 3D spacer, its dislocation on the day of suture removal due to non-compliance with the motor regime. After the infection was relieved, a 3D personalized leg was made for the patient. During preoperative preparation, the patient experiences a fracture of the spacer. Final surgical treatment: in one surgical session, a broken spacer was removed, an anti-protrusion ring with a cup of the Avantage dual mobility system, a personalized 3D implant of the endoprosthesis leg, an NCB plate, and Cable Ready cables were installed. In the lower sections, the leg is fixed in the femoral canal with cement. In the upper parts of the leg there is osseointegration with the bone. This technique made it possible to reinforce the femur intramedullary, compensate for the existing bone deficiency in the lower third of the femur, restore the range of motion in the joint, minimizing the risks of dislocations with double mobility, and provide support to the limb. The total follow-up period for the patient was more than 13 years.</p></sec><sec><title>Conclusion</title><p>Conclusion: The presented clinical case illustrates one of the methods of a possible personalized approach to replenishing the existing deficiency of bone tissue of the lower third of the femur, which arose as a result of multiple surgical interventions on the hip joint associated with coxarthrosis and endoprosthetics.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>Тотальное эндопротезирование тазобедренного сустава</kwd><kwd>перипротезная инфекция</kwd><kwd>ревизионное эндопротезирование</kwd><kwd>спейсер</kwd><kwd>персонифицированный 3D имплант</kwd><kwd>цементная и бесцементная методики эндопротезирования</kwd></kwd-group><kwd-group xml:lang="en"><kwd>Total hip arthroplasty</kwd><kwd>periprosthetic infection</kwd><kwd>revision arthroplasty</kwd><kwd>spacer</kwd><kwd>personalized 3D implant</kwd><kwd>cemented and cementless arthroplasty techniques</kwd></kwd-group><funding-group><funding-statement xml:lang="ru">исследoвание не имело cпoнсорской пoддержки</funding-statement><funding-statement xml:lang="en">the study had no sponsorship</funding-statement></funding-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Цед А.Н., Муштин Н.Е., Дулаев А.К., Шмелев А.В. 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