BACKGROUND: Correction of sagittal imbalance in patients with degenerative spine conditions is typically achieved through corrective decompressingstabilizing procedures that restore angular relationships in the spine. In some cases, however, surgeons have observed an improvement in both regional and overall balance after isolated decompressions. The question that remains is what mechanisms and factors contribute to the spontaneous correction of sagittal alignment after lumbar decompression surgery.

AIMS: to determine changes in the sagittal profile of the spine after decompression surgery in patients who have undergone decompression surgery for degenerative lumbar stenosis.

MATERIALS AND METHODS: prospective observational study of 96 patients who underwent microsurgical decompression for degenerative lumbar stenosis at all clinically significant levels. Clinical and radiological outcomes were assessed by measuring various parameters of the sagittal profile, such as Pi, Pt, SS, low LL, LL, SVA, and Barrey index, both before and 6 months after surgery.

RESULTS: In the postoperative period, a significant increase in lower lumbar lordosis LowLL (L4-S1) (p=0.03), an increase in segmental angles L2-L3, L3-L4, L4-L5, L5-S1 (p<0.05), a decrease in the Barrey index (p=0.048), indicating a spontaneous correction of regional and global balance of the spine without surgical correction of vertebral-pelvic parameters. Significant predictors of this correction after isolated lumbar decompression were the Pelvic Incidence value before surgery (p=0.07), the patient's age (p<0.001), and the SVA value before surgery (p=0.002).

CONCLUSIONS: In isolated decompressive surgeries performed on patients with degenerative spinal stenosis, there has been an improvement in both regional and global sagittal alignment parameters. This means that there has been a spontaneous correction of the balance without the need for any corrective measures. Predictors for this spontaneous balance correction include a Pi value, a patient age, and a preoperative SVA value. Isolated decompression of the intracranial neurovascular structures at the lumbar level can sometimes eliminate orthopedic issues that were not initially targeted by surgery.

Relevance: the study considers the screening of musculoskeletal disorders (MSDs) in nearly healthy employees working in hazardous high-risk environments. The paper presents a newly developed method to assess MSDs and obtained examination results in the Russian EMERCOM employee cohort.

The objective is to develop and test a new MSD assessment method in nearly healthy subjects employed by the EMERCOM of Russia.

Materials and methods: the study involved 170 fire-rescue taskforce officers of the Russian EMERCOM, including 119 nearly healthy subjects and 59 in-patients undergoing MSD treatment. All subjects were males of 32.8 years average age (ranging from 19 to 45 years). The study utilized the innovative method for MSD Evaluation in Nearly Healthy Individuals, as well as the Oxford Knee Score, the Womack scale, and expert evaluation. The Mann-Whitney U test and the Kruskal-Wallis H test were utilized for statistical analysis.

Results and discussion. Ten orthopedics and traumatology practitioners were engaged to evaluate the significance of 58 indicators from the MSD Evaluation checklist developed on the basis of the International Classification of Functioning, Disability, and Health (ICF) (Tsykunov, 2020), in order to outline the most informative indicators for MSD assessment in nearly healthy individuals exposed to hazardous and high-risk occupational environments. Thirteen most relevant indicators were selected to develop the innovative checklist for MSD Evaluation in Nearly Healthy Individuals. The checklist was applied to examine 170 officers of the Russian EMERCOM. Statistics in the nearly healthy subjects was analyzed and compared to the MSD group, considering the age difference and severity of impairment.

Conclusion: the new method demonstrated efficiency as a valid tool for MSD screening at regular medical examinations of nearly healthy individuals working in hazardous and/or high-risk environments, including the Russian EMERCOM officers. The study revealed that 66% of the examined EMERCOM employees presented with various MSDs, including mild (30%), moderate (24%), and severe (12%) disorders.

Introduction. The generally recognized risk factors for osteonecrosis of the femoral head are hip joint trauma, glucocorticoid intake, alcoholism, Gaucher disease, sickle cell anemia, etc.. The incidence of this disease has been studied recently. At the same time, there is no consensus in the literature regarding the contribution of various etiological variants to the development of osteonecrosis of the femoral head.

Purpose of the study: to study the morbidity structure of osteonecrosis of the femoral head with regard to background diseases and risk factors.

Material and Methods 92 patients with osteonecrosis of the femoral head were included in the cross-sectional study. Information was collected by analyzing the archival material and a telephone survey. The patients' somatic status was analyzed, risk factors for osteonecrosis were identified and their contribution to the development of the disease was evaluated. After dividing patients into subgroups (age < 50 years, age ≥ 50 years) the reliability of the values was determined in the STATISTICA program by calculating the p-value by Fisher's exact two-sided test.

Results It was found that the leading causes of osteonecrosis were alcoholism, glucocorticoid use, and trauma of the hip joint, with the frequencies of 20.7%, 17.4%, and 16.3%. The development of femoral head osteonecrosis in the absence of any known predisposing factors was detected with the highest frequency of 35.7%. When analyzing the effect of patient age (< 50 years, ≥ 50 years) on the incidence of risk factors for osteonecrosis of the femoral head, no significant differences were found for any factor.

Conclusion Idiopathic osteonecrosis prevails among the etiological variants in the structure of femoral head osteonecrosis. The most common factors for the femoral head osteonecrosis are alcoholism, glucocorticoid intake and trauma of the hip joint.

Introduction: HIV infection is often accompanied by the development of the femoral head necrosis, but the pathogenesis of this process is still not fully understood. There are few studies in the literature indicating a direct effect of human immunodeficiency virus on osteocytes and osteoblasts. In previously published clinical observations, we presented data on the detection of human immunodeficiency virus RNA directly in foci of osteonecrosis of the femoral head, including those with undetectable viral load in the blood [12].

Purpose of the study: to present the first results of clinical observations in HIV-infected patients with femoral head necrosis, in whom HIV RNA was detected in the focus of bone necrosis.

Methods: patients with HIV infection and femoral head necrosis with undetectable viral load in blood plasma, in whom the viral load in the foci of bone destruction was determined by PCR, were included in the study (n=16). Based on the study of the biopsy material, patients were divided into two groups based on the presence of bacterial agent (coxitis) (n=7, group 1) and its absence (aseptic necrosis) (n=9, group 2).

Results: despite the absence of a significant difference in the groups in terms of the level of CD4 T-lymphocytes, the number of patients with severe immunodeficiency (CD4 T-lymphocytes less than 350 cells/μl) in the group 1 was 42.9% (3/7), in the group 2 was 22.2% (2/9), which suggests, with increasing sample sizes, a greater severity of immunodeficiency in patients with coxitis. Viral load in foci of necrosis in patients of both groups was significantly higher than the undetectable level. In the group 1 treatment was carried out with a with a cement spacer saturated with antimicrobial agents, depending on the individual sensitivity of the pathogen. In the group 2 one-stage arthroplasty was performed. During the follow-up period from 4 to 16 months in the group 1 the average Harris scale score after the first stage of surgery was 61.2±2.4 (23.4±5.1 on admission), and in both patients with tuberculous coxitis progression of the local specific process was noted. In the group 2 after treatment the average Harris score was 87,2±4,5 against 26,7±7,6 on admission, no postoperative complications were noted during the observed period.

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.

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.

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.

Introduction. Lesions of the sacrococcygeal spine hemangioma are quite rare (up to 1% of cases of all spinal hemangiomas). Publications devoted to the surgical treatment of patients with this level of localization of aggressive hemangioma do not give a clear idea of the preferred surgical techniques.

Research objective. To analyze and demonstrate the surgical treatment result of a patient with aggressive hemangioma of the S2 vertebra. Material and methods. Balloon kyphoplasty with using left-sided transcutaneous transpedicular access was performed on a 36-year-old patient

Results. The pain syndrome intensity before surgery was 8 points on the visual analog scale (VAS), after surgery 2 points. According to the Oswestry questionnaire (ODI), life limitations were estimated at 16 points before treatment, and 4 points after surgery. VAS and ODI indicators were 0 points a month after surgical treatment. Computed tomography performed on the 1st day after surgery showed complete filling of the defect with a bone composite without its moving outside the vertebral body. Repeated examination 6 and 12 months after surgical treatment revealed no signs of tumor recurrence.

Conclusion. The presented clinical case may be of interest to a wide audience, due to the insufficient information of the issues of surgical treatment of aggressive spinal hemangiomas of rare localization in the sacrum area.

Introduction: the problem of definition and classification system of flatfoot is widely discussed in modern literature. Most often, the term “AAFD” Adult Acquired Flatfoot Deformity can be found. Acquired flatfoot in adults is multicomponent and includes disorders such as tibialis posterior tendon dysfunction, tibialis posterior tendon rupture, peritalar foot instability and peritalar foot subluxation, as well as progressive planovalgus or equinoplanovalgus foot deformity. In view of this “versatility” of flatfoot, there is a need to identify the primary element in the pathogenesis of the disease and to create a classification that takes into account the progressive nature of the deformity. It is widely believed that dysfunction of the tibialis posterior tendon is the primary element in the pathogenesis of flatfoot. Of course, all of the described components of pes planus are associated with dysfunction of the tibialis posterior tendon. However, the question of the primacy of tendon dysfunction is currently debatable, since there are descriptions of primary deformation of the midfoot or ankle joint in acquired flatfoot in adults. One of the most common and frequently used classifications for assessing acquired flatfoot in adults is the classification presented by Johnson and Strom (1989), which was then modified by Myerson (1997). It is based specifically on dysfunction of the posterior tibial tendon, without considering the other components of the deformity. Many attempts have been made to create a more correct and complete classification system that would include all components of acquired flatfoot in adults. However, despite the fact that the new classification systems took into account the anatomical variability of the deformity, none of them was able to put an end to the issue of the primary element in the pathogenesis of acquired flatfoot.

Aim: to present a new classification system for adult flatfoot deformity.

Materials and methods: A review of the literature over the past 10 years was performed in databases such as PubMed, Scopus, Google Scholar, eLibrary. Articles, original studies, case reports, and previous systematic reviews of the literature were identified.

Results: We have presented a new nomenclature for flatfoot for use in the practice of domestic orthopedic traumatologists: “Progressive Collapse of an Adult Foot” (PCAF) and a new classification system aimed at summarizing the latest data based on the recommendations of the community of leading surgeons in this field. area, and standardize the assessment of this complex three-dimensional deformation. The proposed classification system is based on modern understanding of the causes of planovalgus foot deformity in adults and allows for a more accurate assessment of the stage of the disease and standardization of the deformity assessment process.

Introduction: In 25% of cases, Achilles tendon injuries are diagnosed with a delay. A large number of techniques for reconstructing chronic soft tissue injuries have been proposed, ranging from local tissue plasticity to Achilles tendon endoprosthetics. The main problem that arises during large reconstructions of the Achilles tendon is the risk of postoperative infectious complications, associated with the peculiarities of blood supply to the posterior surface of the lower leg. To minimize such complications, a method of endoscopic transposition of the long flexor tendon of the first toe to the calcaneus has been proposed. Purpose of the study: demonstration the method of endoscopic transposition of the long flexor tendon of the first toe to the calcaneus with a step-by-step description, as well as to review the current literature on the transposition of the long flexor tendon of the first toe.

Materials and Methods: We demonstrated the methodology for performing the surgical intervention and conducted an analysis of the literature data from scientific article databases such as PubMed, Google Scholar, Elibrary, and Cyberleninka over the past 10 years using the method of endoscopic transposition of the long flexor tendon of the first toe to the calcaneus.

Conclusions: Endoscopic transposition of the long flexor tendon of the first toe in chronic ruptures of the Achilles tendon is an effective and minimally invasive technique that does not lead to significant biomechanical disturbances. However, the procedure requires expensive equipment and the corresponding surgical skills of the physician, which may limit the widespread use of this technique.

There is no doubt that total hip replacement is an effective method for treating stage 3 coxarthrosis, however, the increase in primary endoprosthetics inevitably, sooner or later, leads to an increase in revision interventions on the hip joint. Quite often, during a revision operation, a surgeon has to deal with a large bone defect in the acetabulum, dissociation of the pelvic bones, a deficiency of its walls and situations when implantation of serial components is impossible. Additive technologies using personalized 3D implants come to the rescue. The aim of the work was to clarify the role of 3D implants in modern hip arthroplasty, when the use of standard "industrial" components is impossible. The literature review included a search of available databases with an analysis of 54 relevant articles related to the reconstruction of acetabulum defects, while 32 publications cover the period over the past 5 years. Based on the literature analysis, it is concluded that non-standard, complex cases of repeated endoprosthetics are an indication for the use of 3D personalized structures, and the advantages of the technique are indicated. At present, this direction in reconstructive orthopedics of the hip joint is a promising direction. These additive technologies may become the last surgical option when the possibilities of other surgical treatment methods are exhausted.