Pathomorphology of Femoral Head Lesions and Some Clinical and Morphological Dependences in Patients with Dysplastic Coxarthrosis

Methods: We studied femoral head tissue in 22 patients. Clinical parameters were taken into account -the age of patients, the duration of the disease, the intensity of the pain syndrome according to the visual analogue scale. Based on the detected pathohistological changes in the tissues of the femoral head, several morphological gradation indices were taken into account, which diversify the degree of severity of dystrophic-destructive changes.


Pathomorphology of Femoral Head Lesions and Some Clinical and Morphological Dependences in Patients with Dysplastic
Coxarthrosis 24 the intensity of pain in a patient before and after arthroplasty for DKA on the parameters of VASH it was found that the average parameter of the studied indicator was in the range of values of mild pain. After the operation, in all patients, the parameters of pain intensity for VAS decreased, but the average value also remained in the range of values of mild pain. Pathomorphological changes of the femoral head were characterized by a complex nature and varying degrees of severity. In some cases, a significant deformation of the surface was observed, in particular conical, saddle-shaped ( Figure 1) or irregularly wavy, which was designated as a high-grade gradation. If the sphericity of the head was slightly disturbed, the gradation corresponded to a low degree. The most significant pathological changes were observed in the tissues of the articular surface of the femoral head. CX rarely looked unchanged or slightly changed, which would correspond to a low degree of dystrophic-destructive changes ( Figure 2). Slightly altered CX occurred mainly in the areas unloaded head surface. The thickness of the CX in different parts of the surface of the femoral head varied significantly: from slightly altered CX to its complete absence on the articular surface ( Figure 3). Areas of exceptionally dystrophic changes differed from normal hyaline CX by uneven matrix density, unmasking of collagen fibers ( Figure 2) and sometimes by chondrocyte necrosis, which was regarded as low-grade dystrophic-destructive changes (DDD). For the most part, in addition to dystrophic changes, signs of destruction of the CX of the femoral head were determined: superficial and deeper defects of the matrix, horizontal and vertical cracks, defibering, fragmentation and desquamation of CX areas ( Figure 4) large areas of interstitial chondronecrosis, large clusters-proliferates of chondrocytes. If the destruction of CX did not extend deeper than the intermediate zone of CX, the severity of DDZ was regarded as average. In cases where only areas of deep zone cartilage remained from CX or cartilage tissue on the surface of sclerosed bone tissue was absent, the severity of DDZ was high.     Hematoxylin and eosin. Coll. 12.

Pathomorphology of Femoral Head Lesions and Some Clinical and Morphological Dependences in Patients with Dysplastic
Coxarthrosis 28 Among the frequent and characteristic pathological changes in the subchondral bone plate of the femoral head should be mentioned areas of dystrophic CX (Figure 7). In some places, they were close to the cartilage preserved on the surface, but often such cartilaginous islets were not directly associated with the cartilaginous tissue of the deep CX zone and had a rather polymorphic appearance.
The altered bone tissue of the articular surface of the femoral head also contained the characteristic round-oval shape of the fibrosing site -in these places the mature fibrous tissue replaced the site of osteoresorption, which probably occurred due to osteonecrosis of the

Pathomorphology of Femoral Head Lesions and Some Clinical and Morphological Dependences in Patients with Dysplastic
Coxarthrosis 29 General morphological assessment of the severity of DDZ in the femoral heads of patients with DKA. The general morphological assessment was made according to the known stages of osteoarthritis [16][17][18][19]. The criteria were changes that reflected the degree: • Decrease in the thickness of the CX and the severity of the DDZ of its CX matrix (leading feature).
• Severity and prevalence of characteristic pathological changes in the tissue of subchondral spongiosis of the head.
• Deformation of the articular surface of the head.
According to the available pathological changes of the head, the low degree of DKA (I) is exposed only in one case, medium (II) -in 9, high (III) -in 11.
Differences in the frequency of pathological changes in certain areas of the femoral heads. In the loaded areas of the femoral heads, in contrast to the unloaded, changes of high severity were more often observed ( Table 2): deformation of the joint surface, changes in the thickness of the CX, high or medium degree of DDZ in subchondral spongiosis. In unloaded areas of the femoral heads, the values of a high degree of the index were found for marginal cartilaginous growths. However, the comparison of the incidence of cases of a certain degree of severity of pathological changes in different parts of the articular surface of the heads did not reveal statistically significant differences.

Pathomorphology of Femoral Head Lesions and Some Clinical and Morphological Dependences in Patients with
Correlations of clinical and morphological parameters in patients with DKA. Correlation analysis of indicators that made up the pairs of cases "clinic -morphology" (Table 3) revealed the relationships that had the highest parameters of the association coefficient, between the following indicators: -"prescription of the disease" -"the thickness of the CX on the surface of the head" -the dependence is positive, medium strength, with a probability of error p < 0,1. This means that more than a third of patients with DKA with a disease duration of more than 18 years, the thickness of the CX of the femoral head is significantly reduced and corresponds to the gradation of a high degree of this indicator; -"type of displacement of the femoral head (according to Crowe)" -"Marginal cartilaginous growths" -the dependence is positive, close to the range of average strength, probable (p < 0,05). This means that almost half of patients with DKA with displacement heads of degree II -IV according to Crowe marginal cartilaginous growths of high degree are probably present; -"VAS index before surgery" -"marginal bone and cartilage growths" -the dependence is positive, close to the range of medium strength, probable (p <0.05), i.e. almost half of patients with DKA who had high parameters degree indicator of YOUR, marginal bone-cartilage growths of considerable expressiveness are probably present; -"your difference before -after surgery" -"thickness of CX on the surface of the head" -the dependence is positive, weak, probable (p < 0.05), i.e. almost half of patients with DKA who had a high degree of parameter indicator "YOUR difference before -after surgery" (more than 2), it is probably combined with a significant reduction in the thickness of the CX; -"indicator of your difference before -after surgery" -"dystrophic-destructive changes in the sponge of the head" -the dependence is positive, weak (p < 0,1), i.e. almost half of patients with DKA who had a high degree of parameter indicator "YOUR difference before -after surgery" (more

Pathomorphology of Femoral Head Lesions and Some Clinical and Morphological Dependences in Patients with Dysplastic
Coxarthrosis 31 Previously studied the condition of the hip joints in patients with DKA concerned biomechanical modeling of the analysis of clinical manifestations, anamnestic data, X-ray morphometric parameters and the results of treatment of patients with coxarthrosis caused by DCS [20]. It was found that the most prognostically significant X-ray morphometric marker of the course of DKA is the value of the angle of the bearing surface of the acetabulum relative to the horizontal: the larger it is, the sooner we can expect to compensate for the course.
As the value of the angle of inclination of the surface of the acetabulum increases, the values of the shear forces directed laterally and forward increase proportionally. Using factor analysis, the most important indicators for predicting the course of DKA were established.
Among the primary factors, in addition to the value of the angle of inclination of the bearing surface, is also determined by the age of onset of signs of the disease and the force of shear acting in the joint. In addition to these indicators, the classification developed by the author also considers the cervical-diaphyseal angle, which reflects the degree of dysplasia of the proximal femur. However, in this work it is sug- Another work devoted to the study of the structure of the acetabulum under the conditions of DKA, which determined the X-ray anthropometric characteristics of the acetabulum, found that DKA is characterized by an increase in the width of the acetabulum and the thickness of its bottom against a decrease in depth and index depressions, which made it possible to distinguish a special specific dysplastic deformation [3]. In this case, a probable direct strong correlation was found between the degree of DKA according to Eftekhar  Pathohistological examination of the CX of the femoral head of 45 patients with spondyloepiphyseal dysplasia, performed with our participation, revealed some pathological changes mainly in the CX matrix. Violation of the distribution and orientation of type II collagen was found, which negatively affects the mechanical strength of CX and causes the development of DKA at a young age. It is also shown that in subchondral spongiosis of the femoral head an inflammatory process continues, which is accompanied by destructive disorders in the tissues of the subchondral bone plate. In some cases, productive inflammation was found in the capsule of the hip joint, which suggests its role as an important pathogenetic factor in the development of trophic disorders of the CX tissue and the progression of DDZ of the hip joint [2,9]. In

Conclusion
As a result of pathomorphological examination of the femoral head, performed on biopsy-resection material from patients with DKA, who performed TEP CS, found the presence of signs of dystrophic-destructive lesions of the articular end of the head and some features that give grounds to consider morphological manifestations of DKA as such that do not always coincide.
In the complex of pathomorphological changes of the articular surface of the femoral head the most significant are deformation of the articular surface, reduction of CX thickness due to its dystrophy and destruction, superficial and marginal cartilaginous growths, dystrophic, ischemic-necrotic, destructive and reparative and reparative. These pathological changes occur with different frequency and in some cases are combined in different degrees of severity.
There are correlations between separate clinical indicators of patients and morphological indicators of a condition of fabrics of a head of a femur on DKA from which the largest parameters of coefficient of association have such pairs. "Clinic-morphology": • "Prescription of the disease" -"the thickness of the CX on the surface of the head" -the dependence is positive, moderate.
• "Type Of displacement of the femoral head (according to Crowe)" -"Marginal cartilaginous growths" -positive dependence, close to the range of medium strength.
• "Your index before surgery" -"marginal bone and cartilage growths" -the dependence is positive, close to the range of average strength, probable.
• "Your difference before -after surgery" -"thickness of the CX on the surface of the head" -the dependence is positive, weak.
• "Your indicator difference before -after surgery" -"dystrophic-destructive changes in the spongiosis of the head" -the dependence is positive, weak.