Medical Rehabilitation of Patients Suffering from Avascular Necrosis of the Femur Head Undergoing Joint Replacement Surgery

BACKGROUND. Avascular necrosis of the femoral head (AVN) is a severe progressive and disabling clinical entity affecting relatively young and working-age individuals, leading to the patient’s disability and a sharp decrease in their physical and social activity.This condition characterized by the death of osteocytes in the loaded area of the femoral head. Osteonecrosis is a condition that results from impaired local blood flow, which can be caused by a variety of factors. Thes e include trauma, surgical procedures, hip dysplasia, inflammatory conditions, blood clotting disorders, use of glucocortic oid medications in the treatment of other conditions, and the effects of radiation or chemotherapy. However, during the period 2021–2023, cases of avascular necrosis of the femoral head in patients who had undergone COVID-19 treatment began to be reported in the medical literature. The authors have pinpointed three potential factors that could contribute to this condition: the utilization of glucocorticoids, vasculitis, endothelialitis, and thrombotic angiopathy, as well as the osteonecrotic impact of the COVID-19. To date, the gold standard treatment for advanced aseptic necrosis of the femoral head is total hip replacement surgery. The proportion of patients in this group ranges from 10% to 12% of all endoprosthetic implant recipients.

The article details a group of individuals with aseptic necrosis of the femoral heads, who contracted COVID-19 in 2021– 2022 and underwent total hip replacement surgery in 2023–2024 During the early and late post-operative periods, the patients underwent medical rehabilitation at the second and third stages, in a specialized department, following their personalized treatment plan.

AIM. The article aimed to determine the tactics and outcome of medical rehabilitation in patients suffering from avascular necrosis of the femoral heads, who have undergone total hip replacement surgery, taking into account the assessment of rehabilitation prognosis, the use of physical and medical rehabilitation methods.

MATERIALS AND METHODS. The study involved 174 patients from the medical rehabilitation department of the Clinical Hospital of the INC SB RAS who had hip endoprosthesis implants, with 46 of them presenting with aseptic necrosis of the femoral heads. 46 individuals contracted COVID-19 between 9 and 13 months prior to their operation. They received standard laboratory tests, general therapy, and orthopedic evaluation, as well as assessments of physical activity, integrated rehabilitation, and the Harris scale. According to the medical rehabilitation scale, patients are classified as category 4–5. All performed studies of the level of vitamin D in the blood serum. All received physiotherapeutic procedures, exercise therapy, igloreflexotherapy, mechanotherapy, hip contracture management in the apparatus of passive and active mobilization of the hip and knee joints, training in the correct weight distribution on stabilloplatform. In addition, the medical rehabilitation fragment included combined osteoprotective therapy: ibandronic acid 3 mg/3 ml (bonviva) 1 times per 3 months (for 9–15 months), alphacalcidol 0.5–1 μg per day (alpha D3-Teva), dipyridamol 75 mg per day (curantil) 10 days, nimesulide 100 mg 2 times on the day of 10 days. Following individual testing by a medical psychologist, the Ortorent Cognitive apparatus underwent correction to improve psychological well-being and prevent disorders. Statistical methods of processing the obtained results were carried out. The study was approved by the Biomedical Ethics Committee of the Irkutsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences (Extract from Meeting No. 74-2 of 30.01.2023). A positive opinion of the Russian Academy of Sciences No. 1022040600618-4.3.2.10 of 09.01.2023 was received for the study

CONCLUSION. As a result of medical rehabilitation of patients suffering from aseptic necrosis of the femoral heads, who underwent implantation of hip endoprostheses, pain syndrome was relieved, locomotor function was optimized, contracture of the operated hip joint was significantly reduced, physical activity was expanded, laboratory tests of peripheral blood were improved.

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