[Diseases of proximal femur segment in subjects of working age]

A high-energy injury in subjects under the age of 50 as a rule leads to hip dislocation. This condition requires urgent orthopedic aid to avoid the risk of femur head osteonecrosis. Given a failure of closed reduction of dislocation (to be performed within 6 hours after the injury), immediate open reduction is indicated. The surgical approach depends on the dislocation type. The Kocher-Langenbeck approach is practiced to treat posterior dislocation and the Smith-Petersen or Watson-Jones approach in case of anterior dislocation. The most frequent and dangerous complications are femur head osteonecrosis (in 4-22% of the cases even after timely reduction) and post-traumatic coxarthrosis. Osteonecrosis is managed by a variety of surgical methods, viz. central decompresson, osteoplasty, corrective osteotomy, endoprosthetics. Its late stages, with sclerosis affecting over 30% of the head surface, are treated by resurfacing arthroplasty, hemiarthroplasty, total surface arthroplasty, uni- and bipolar hemiarthroplasty, total endoprosthetics, and administration of expanded stem cells into the subchondrial layer. The use of tissue-engineering technologies for the treatment of osteonecrosis is not confined to the treatment of its precollaptoid stages. They can be employed to promote osteointegration at the metal-bone interface and thereby to improve secondary stability or prolong the hardware lifetime.