Background. Knee arthritis and associated chronic pain is a very common problem. Radiofrequency ablation (RFA) of genicular nerves in knee arthritis managament was introduced recently but rigorous studies are lacking.
Objective. To compare the efficacy of RFA of genicular nerves and nonoperative treatment in patients with symptomatic knee arthritis.
Methods. This prospective controlled study included 65 patients with symptomatic knee arthritis and associated knee pain. Thermal RFA of genicular nerves was used in 31 patients under the fluoroscopy guidance (RFA group); complex outpatient conservative treatment was performed in 34 patients (CT group). We compared Visual Analog Scale (VAS) score, functional state of knee joint according to WOMAC scale, Global Perceived Effect of treatment, complications throughout 6 months.
Results. 6 months after treatment, the pain intensity was significantly lower in the RFA group compared to the CT group: 3 [2; 4] vs. 5 [5; 6], respectively (p<0.001). The primary endpoint – a reduction in pain intensity by at least 50% 6 months after treatment – was achieved in 74.2% of patients after RFA, and in 11.8% after CT (p<0.001, Chi-squared=26.0). 6 months after the treatment, WOMAC score in the RFA and CT group were 32.2±5.8 and 45.0±7.8, respectively (p<0.001). Neurological, infectious complications, thermal injuries were not detected.
Conclusion. The study showed that RFA is an effective and safe long-term therapeutic option for managing pain and improving physical function in patients with symptomatic knee OA.

Introduction: As is known, difficulties in revision hip arthroplasty are most often due to the deficiency and quality of bone tissue in the acetabulum. To determine the tactics of surgical treatment and components, various classifications of bone defects are used, which are periodically updated or undergo revision and refinement. However, it must be understood that even using such “convenient” classifications, it is not always possible to assess changes in the acetabular region using planar radiographs. To solve and resolve such controversial cases and the possibility of practical application of various classifications, it is advisable to use a three-dimensional reconstruction even at the planning stage.
Purpose. To determine the role and place of three-dimensional visualization of the pelvic bones in patients with severe defects of the acetabulum according to the classification of A.Gross/K.Saleh.
Materials and Methods: For this experimental study, a questionnaire was developed, consisting of two blocks: acquaintance with the examinee and direct questions on the assessment of 20 clinical cases. The examinees were asked to assess the state of the acetabulum for limited and unlimited bone defects according to the A.Gross/K.Saleh classification solely on the basis of X-ray examination. Subsequently, we compared the responses of surgeons for each clinical case with the type of defect (contained or uncontained) based on a three-dimensional reconstruction performed by the developer of the questionnaire.
Results: The study involved 12 surgeons with different experience in revision surgery. Cohen's Kappa consistency coefficient in the comparative assessment of X-ray image and three-dimensional visualization between students and developers was equal to 0.111 (95% CI 0.03 - 0.256), between experienced specialists - 0.1538 (95% CI 0.02-0.33), between professionals - 0.3043 (95% CI 0.036-0.576), respectively, which in all cases indicates low results, although it has small statistically insignificant differences.
Conclusions: Thus, the results of the experimental study revealed an insufficient understanding of the clinical situation based on planar radiographs (namely, the severity of the bone tissue defect in the acetabular region) and make it expedient to routinely use modern computer technologies in complex cases, namely, three-dimensional visualization.

The purpose - to evaluate the efficacy of aquakinesitherapy in a rehabilitation program for patients with primary hip osteoarthritis after primary total arthroplasty.
Materials and methods. A randomized controlled trial of 90 patients with primary coxarthritis stage 3 according to the Kellgren-Lawrence classification, with II-degree joint dysfunction was carried out. Group I (control) consisted of 30 patients (63[58;70] years old) - rehabilitation treatment was carried out by the method of kinesitherapy after surgery. Group II (n=30) (65[59;70] years) - rehabilitation was carried out by the method of kinesitherapy in the pre- and postoperative period. Group III - patients aged 65.5[59.3;70] years (n=30) - rehabilitation was performed by aquakinesitherapy before and after surgery. All groups were comparable in age, sex, osteoarthritis stage, anesthesiology manual, operative treatment, implant type and comorbidity. Evaluation of the effectiveness of rehabilitation was determined by laser optical topography (DIERS®, Germany); Harris scales; muscle strength, scales pain syndrome, and the Spielberger-Hanin questionnaire. Statistical processing was performed by IBMSPSS Statistics Version 25.0.
Results. Analysis of optical topograms showed a significant difference with only 1 group on day 45 after surgery. On the contrary, when comparing clinical and instrumental parameters, the significance of differences was noted not only with group 1, but also between groups 2 and 3 both in the pre-operative (after the course of exercise therapy) and in the postoperative period. Analyzing the data of the questionnaire, it was found that the statistical significance of the differences was established between group 2 and 3 (χ2=9.188, p=0.035) only after surgery.
Conclusion. The use of aquakinesitherapy in a comprehensive rehabilitation program before and after primary total arthroplasty in patients with primary osteoarthritis of the hip joint contributes to an effective effect on the musculoskeletal system, which leads not only to a significant restoration of limb function, but also generally has a beneficial effect on the organism, thereby improving his quality of life.

Introduction. Ligament tears and injuries are one of the most common pathologies of the knee joint. For the purpose of ligament reconstruction and joint stabilization tendon autografts are used successfully in clinical practice. However, these techniques have several flaws and limitations. Thus, developing new methods of ligament reconstruction and application of various biomaterials for these purposes is a relevant route in orthopaedics.
The aim of the study. Evaluation of the collagen membrane’s osteointegration in anterior cruciate and external collateral ligaments’ reconstruction in animal models.
Materials and methods. Experimental study on the animal model. All animals underwent surgical intervention - reconstruction of the anterior cruciate (ACL) and external collateral ligaments (OCL) of the knee joint. Histological examination of the preparations was carried out after the animals were taken out of the experiment.
Results. At all stages there was observed the regeneration of the bone trabeculae in the bone tissue around the implant which testifies to a good ability of the implant to osseointegration. No pathological changes were found in the tissues around the implant at any point of time which proves good biocompatibility of the implanted material.
Conclusion. Tissue engineering and the use of collagen biopolymers for ligament reconstruction is a promising alternative to autoplasty.

Summary. The work is devoted to the treatment of fresh ruptures of the anterior cruciate ligament by plastic method with adductor tendons in comparison with patients with chronic anteromedial instability of the knee joint.
The aim of the study was to study the effect of the duration of the preoperative period of ACL repair on the results of treatment.
Material and method. A total of 68 patients were selected and included in the study, of which 5 (7.4%) patients were excluded, 63 patients were subjected to statistical analysis, 44 men and 19 women, aged 18 to 45 years, mean age 31.3 ± 3.4 years. Two study groups Group I (main -30 patients) duration from injury to surgery from 8 to 21 days (mean - 16.9±6.3 days), II (control – 33 patients) group from 6 months to 15 months (mean - 11.4±5 ,3 months). According to the mechanism of injury, there were: domestic (fall) 28 patients (44.4%), sports - 35 patients (55.6%) amateur athletes. Average height 178.7±9.4 cm, average weight 76.5±7.8 kg, average body mass index (BMI) 27.3±2.3 kg/m², activity level on the Tegner scale before injury not lower than 5 (1–10).
The study used a 10-point visual analogue pain scale (VAS) and a numerological patient satisfaction scale (NSS), Tegner and Lysholm scales, an anterior drawer test, before and after surgery (after 6 and 12 months).
Results. Pain syndrome after surgery in patients of the first group at 6 months was less than in patients of the second group (group I - 1.6 ± 1.5, group II - 1.9 ± 1.0, p = 0.012), leveled off by 12 months . NSV at 6 months after surgery in group I was 8.2±1.8, significantly exceeding the values of group II (7.4±0.8, p<0.001), while 8 (26.7%) patients assessed to a maximum of 10 points, which was not observed in the control group. The Tegner test at 6 months was statistically significantly reduced compared to the preoperative one in both groups, but there was a statistically significant difference of 9.7% between the groups (p<0.001), but by 12 months after the operation it returned to the pre-injury level and the difference between the groups was absent (group I 6.3±1.0 points, group II 6.2±1.5 at p=0.732). The results on the Lysholm scale in both groups had no statistically significant difference (p=0.683).
Conclusion. Early plastic surgery of the anterior cruciate ligament contributes to a faster recovery of the level of physical activity but requires a change in the system of surgical care.

Introduction. Osteomyelitis of the long tubular bones of the extremities and periprosthetic infection (PPI) of actinomycotic origin is extremely rare. Most publications are devoted to actinomycotic osteomyelitis of the lower jaw, bones of the facial skull, sternum and vertebrae. Difficulties in diagnosis lead to a delay in the appointment of etiotropic therapy and a worsening of the prognosis for such patients. The purpose of the study. To evaluate the frequency of detection of actinomycetes in patients with osteomyelitis of long tubular bones and periprosthetic infection and to raise awareness of practitioners about actinomycosis in orthopedic patients. Materials and methods. A retrospective analysis of the frequency of isolation of Actinomyces spp. from patients who were treated in the departments of the center from 01.01.2010 to 31.12.2022. A clinical case of actinomycotic osteomyelitis in a patient who was treated in the department of purulent osteology in 2022 is presented. Results. Actinomycotic osteomyelitis of long tubular bones is a rare localization of the process, leading to frequent errors in diagnostic and therapeutic tactics. There are only descriptions of isolated clinical cases in the literature, and the incidence of periprosthetic infection of this etiology is higher than the lesion of native joints. Conclusion. Actinomycosis, osteomyelitis, periprosthetic infection, bone actinomycosis, antibacterial therapy.

The work is devoted to the analysis of diagnostics and tactics of surgical treatment based on a clinical case of a repeated gunshot bullet wound in the artificial elbow joint.
The patient, a 23-year-old man, received a gunshot wound with destruction of the bones forming the elbow joint, who, after healing of soft tissue wounds, underwent total cement arthroplasty of the elbow joint, the postoperative period was uneventful, and the patient returned to professional activities. However, 4 years after the endoprosthesis replacement, he received a repeated gunshot bullet combined wound of the chest and limbs, while one of the bullets hit the elbow joint endoprosthesis and remained in the soft tissues. The purpose of providing primary surgical care was debridement of wounds and drainage of the pleural cavity. After stabilization of the condition and healing of wounds, a physical and instrumental examination was conducted, it was revealed that the prosthesis was not damaged, and an open removal of the bullet was performed with a favorable outcome.
Conclusion Diagnostic and surgical management of blind gunshot and joint injuries after primary arthroplasty is becoming increasingly important as the number of patients with extremity gunshot wounds continues to rise. A foreign body (bullet) in the patient's body requires a clear diagnostic and surgical approach. The incidence of non-removed or involuntarily abandoned bullets has increased in recent years, while existing treatment protocols are outdated or non-existent. The existing literature on gunshot wounds and residual bullet treatment is small, low-powered studies, so clinical studies need to be continued through well-controlled cohort and multicenter studies.

Relevance: Modern surgery of the forefoot for deformities is most often accompanied by the apecial footwear. The models and types of such shoes differ from each other. There is still no consensus what type of shoes needed for the purpose of unloading the forefoot.
Purpose of the study: To study current approaches in decision-making on the appointment of postoperative shoes to patients with deformity of the forefoot.
Material and methods: a literature review was performed in the PubMed, eLibrary system with the keywords "forefoot postoperative shoes", "forefoot relief shoes", "foot relief shoes", "hallux valgus shoes", "shoes for unloading the forefoot", "postoperative foot shoes". Among all the articles, 18 publications on shoes for unloading the forefoot were selected for detailed analysis.
Results and discussion. Studies on healthy volunteers, for the most part, indicate greater effectiveness in reducing the pressure under the forefoot of shoes with a reverse wedge of the sole. The result of clinical studies was the absence of a difference in the outcomes of operations in patients who wore shoes with a reverse wedge or flat rigid shoes. The effect of shoes on the joints of the lower extremities, the position of the pelvis, and the body has not been studied. The topic of choosing forefoot relief shoes requires not only discussion, but also further scientific research.

Introduction. For many years, unicondylar knee arthroplasty (UKA) has occupied a leading place in the structure of partial arthroplasty, being a surgical method of treating an isolated affected part of the knee joint in patients who sought medical help at earlier stages of osteoarthritis (OA). Partial arthroplasty regains its former popularity and interest on the part of many operating doctors, taking advantage of the inherent advantages that allow you to restore the directly damaged compartment and preserve the normal anatomy of the knee joint in intact departments, which improves the prognosis of such patients and demonstrates good medium- and long-term results.
Materials and methods. The literature review contains information on both current trends and vectors of ACS development, and also highlights the history of the formation and development of one of the methods of partial knee replacement. The purpose of the review is based on the analysis of domestic and foreign literature to review and present up-to-date data on the arthroplasty of the medial knee joint with one condyle. In the course of the work, more than 25,000 articles from domestic and foreign scientific citation databases were analyzed.
Discussion and conclusions. Partial arthroplasty has undergone many changes, modifications and transformations, which have affected both the technical improvement of structures and surgical instruments, and the rethinking of the role and significance of partial arthroplasty in modern times, which has allowed to achieve good clinical results and patient satisfaction. This review analyzes publications, collects information about the stages of development and formation of this method of surgical treatment, although conservatism of views and contradictory opinions about the concept of UKA remain, which demonstrates the continuing interest and relevance of partial arthroplasty at the present time.

Total hip arthroplasty, being a success procedure all over the world, is also success in Russia, with many procedures every year. This leads not only to an increase in the number of revision surgeries, but also to an increase in the proportion of early revisions. In this regard, understanding the current approaches to the assessment of outcomes and patient satisfaction after primary and revision hip and knee arthroplasty as well as their cost-effectiveness is an important key to the systematization of the obtained data and optimization of the available monitoring tools. The aim of the study is to analyze the tools of patient follow-up described in the scientific papers after primary and revision hip arthroplasty and their cost-effectiveness.
Materials and methods. The results of the studies of foreign and native authors, using the PubMed and eLIBRARY search engines were analyzed in the work.
Conclusions. Despite the sufficient volume of the available literature data, the cost-effective systematized approach to the evaluation of results and satisfaction after the primary and revision joint replacement is still an unsolved problem. Studies comparing the costs of performing routine follow-up of patients with the costs of revision surgeries for instability of arthroplasty components in asymptomatic patients that were performed at an early date are needed.
The frequency and timing of follow-up for revision surgeries also remains an unresolved issue and should obviously be different from that for primary surgeries, since revision surgeries are technically more complicated, and their results are usually less encouraging.