ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS

PREDICTION OF REPEATED OSTEOPOROTIC FRACTURES OF THE THORACIC AND LUMBAR VERTEBRAE (EXPERIMENTAL STUDY)

Andrii Popov, Mykyta Moloduk — Tue, 08 Oct 2024 00:00:00 +0300

Objective. To analyze the patterns of occurrence of postoperative recurrent vertebral compression fractures (RVCF) depending on the location of the primary fracture after puncture vertebroplasty. Methods. 520 case histories of patients with osteoporotic fractures of the thoracic and lumbar spine of various locations were analyzed. The total number of treated vertebral bodies was 1,458 (thoracic 596 — 40.88 %, lumbar 862 — 59.12 %). Most often, compression fractures of the spine occurred in the thoracolumbar junction (784 — 53.77 %). RVCF was diagnosed in 64 (12.31 %) people (95 % CI: 9.94–14.68 %) during follow-up examinations, after 1, 3, 6 or 12 months. since the operation. The study was carried out by 3 methods of forecasting: assessment of conditional probabilities, study of the significance of a primary fracture as a predictor of repeated fracture in a specific vertebra, analysis of associative rules and relationships Results. According to the 1st method, all conditional probabilities do not exceed 0.4 and the highest of them are the probabilities L_I and L_IV RVCF (0.39) with a primary Th_VI fracture, and the probability of Th_VIII RVCF (0.38) with a Th_V primary fracture. Method II found only two regularities that allow an interpretation that corresponds to the purpose of our research. The third method revealed the associative rules and connections of the primary fracture of Th_V with RVCF L_I, Th_XII; according to Th_VI with RVCF L_I, L_II; in the case of Th_VIII with RVCF L_I, Th_XII; Th_X fracture with Th_X, Th_XI, Th_XII, L_II RVCF; under Th_XI conditions with Th_V, Th_VII, Th_VIII, Th_IX, Th_X, Th_XII RVCF; for Th_X with RVCF Th_IX, Th_XI, Th_XII, L_II; Th_X fracture with Th_X, Th_XI, Th_XII, L_II RVCF. Conclusions. Prediction of repeated osteoporotic fractures is an important
and topical problem of todayʼs vertebrology. Our study shows the most vivid patterns that are characteristic of the general sample of patients, namely: with a primary fracture of Th_XI — a new deformation of Th_VIII is possible; in the case of Th_VII — new fractures of Th_IX, Th_XII, L_I; for Th_XII — injuries of Th_XI; primary L_I — new Th_XII, L_IV, L_V.

ANALYSIS OF THE EFFECTIVENESS OF INDIRECT SPINAL CANAL DECOMPRESSION IN THE TREATMENT OF BURST FRACTURES AT THE THORACOLUMBAR JUNCTION

Oleksii Nekhlopochyn, Vadim Verbov, Ievgen Cheshuk, Milan Vorodi — Tue, 08 Oct 2024 00:00:00 +0300

Indirect decompression of the spinal canal through ligamentotaxis is one of the methods for remodeling the spinal canal in traumatic stenosis. Objective: To evaluate the effectiveness of indirect decompression of the spinal canal for different morphological types
of burst fractures of vertebral bodies at the thoracolumbar junction. Methods. A preoperative and postoperative analysis of computed tomography scans was performed on 59 patients who were treated at the«Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine» for burst fractures at the thoracolumbar junction. The criterion for the effectiveness of indirect decompression was the area of the spinal canal, measured at the level of injury in the zone of maximum compression. The grading of burst
fractures was performed using the classification by F. Magerl et al. (1994). Results. In the preoperative period, the median degree of stenosis in the group of patients was 43.47 % (95 % confidence interval
(CI): 37.53–46.22 %). For damage type A3.1, it was 36.9 % (95 % CI: 28.1‒40.5 %), for type A3.2 — 46.1 % (95 % CI: 32.1‒54.5 %), and for type A3.3 — 47.6 % (95 % CI: 37.5‒56.5 %). After surgical treatment, the degree of stenosis decreased by 20.14 % (95 % CI:
15.93‒21.56 %). For type A3.1, the effectiveness was 20.1 % (95 % CI: 9.5‒22.7 %), for type A3.2 — 15.2 % (95 % CI: 7.51‒17.3 %), and for type A3.3 — 21.7 % (95 % CI: 20.8‒26.4 %). The difference between types A3.2 and A3.3 was statistically significant (p = 0.0018).
It was found that indirect decompression is most effective with higher degrees of stenosis. For Grade I by D. Wolter (1988), the canalexpansion achieved was 7.07 % (95 % CI: 5.69‒8.65 %), for Grade II — 21.6 % (95 % CI: 20.4‒22.7 %), and for Grade III — 30.3 % (95 % CI: 27.0‒33.6 %). Conclusions. Closed remodeling of the spinal canal with transpedicular fixation and the effect of ligamentotaxis is an effective method for correcting traumatic spinal canal stenosis at the thoracolumbar junction. The effectiveness of the technique is determined by many factors, including the type of burst fracture, the initial degree of stenosis, and the level of injury.

Оutcome of neglected posterior elbow dislocation with gross ligamentous instability by arthrolysis combined with circumferential reconstruction of MCL, LUCL using triceps tendon fascia

Santosh Kumar Sahu, Nihar Ranjan Mishra, Chinmay Sahu, Dattatreya Kar — Tue, 08 Oct 2024 00:00:00 +0300

Dislocation of the elbow joint, which has not been treated for more than 3 weeks, is considered outdated. Due to the high risk of complications and the uncertainty of the effectiveness of the treatment of an old dislocation of the elbow joint, it is quite a difficult task for surgeons. There are various described techniques for repairing the lateral ligamentous complex (including the LUCL) and the medial collateral ligament. Objective. To describe the author's unique technique, which consists in using one graft to restore both lateral and medial ligaments. Methods. The personal experience of treating 14 patients with chronic dislocation of the elbow joint with deformation and multidirectional instability is presented. All patients were operated on by one surgeon using the arthrolysis method in combination with MCL, LUCL reconstruction using an ipsilateral autograft of the triceps tendinous fascia. Further observation was carried out at 3, 6 and 12 weeks, as well as at 6 and 9 months. In our case, we evaluated stability, range of motion, and the presence of pain syndrome. The results. Satisfactory results were obtained in terms of pain-free full range of motion and adequate stability of the elbow joint in all cases. All patients performed their active routine exercise with minimal limitation. Conclusions. The advantage of the technique is a unique comprehensive approach that uses one circular graft to restore both the lateral and medial ligament complexes, which ensures stability and possible early rehabilitation. This leads to an excellent functional result — a quick restoration of the full range of motion in the joint and its stability.

PERCUTANEOUS RELEASE OF THE MEDIAL COLLATERAL LIGAMENT DURING KNEE ARTHROSCOPY

Maksym Golovakha, Yevhen Bilykh, Volodymyr Pertsov — Tue, 08 Oct 2024 00:00:00 +0300

The complete visualisation of the internal joint space is crucial for effective knee arthroscopy. However, limited access to certain areas can lead to complications, including cartilage damage. Percutaneous partial release of the medial collateral ligament has been shown to effectively widen the medial compartment of the joint. Objective. This study aimed to determine the effect of percutaneous release of the medial collateral ligament on the postoperative period and restoration of knee joint function. Methods. The patients were divided into two groups: the study group (n = 32) and the comparison group (n = 36). T he study group underwent partial resection of the medial meniscus in combination with percutaneous partial release of the medial collateral ligament, while the comparison group underwent only partial removal of the medial meniscus without widening the medial joint gap. The assessment included pain, functional recovery according to the Tegner Lisholm scale, and the possibility of developing medial instability. Results. The analysis of VAS scores showed a significant reduction in pain in both groups over time. However, there was no significant difference in pain intensity between the two groups during the study. According to the Tegner Lysholm scale, there was a statistically significant improvement in the functional status of patients 6 months after surgery compared to preoperative values in both the study group (p = 0.0034) and the control group (p = 0.0071). However, there was no statistically significant difference between the groups on t he s ame s cale ( p = 0 .871). The study g roup s howed a s light increase in valgus deviation of the tibia (no more than 5o) in 14 (43.75%) patients during the valgus stress test performed on days 7–10 postoperatively. However, after 6 weeks, none of the patients reported any subjective instability or weakness of the knee joint. Therefore, it can be concluded that the procedure was successful. Conclusion. Percutaneous release of the medial collateral ligament to widen the medial aspect during knee arthroscopy has no effect on the postoperative period or the results of partial removal of the medial

meniscus.

TECHNOLOGY OF MINIMALLY INVASIVE SURGICAL CORRECTION FUNNEL-SHAPED DEFORMATION OF THE CHEST IN CHILDREN

Marianna Kaminska, Valery Dihtiar — Tue, 08 Oct 2024 00:00:00 +0300

The most common method surgical treatment of pectus excavatum (PE) is thoracoplasty according by D.Nuss at the moment. But serious complications associated with trauma to the pericardium, blood vessels, and bleeding are known. Objective. Development of a modified technology surgical correction of pectus excavatum, which involves exclusively extrapleural passage of the plate, according to the individual size and shape of the deformation of the patient’s chest, in order to prevent intraoperative complications. Methods. 81 patients aged 10 to 17 years were involved in the study. A modified technology of extrapleural surgical correction of PE was performed. The plate was carried level of the VI–VII sternocostal joints through the formed through submuscular-extrapleural retrosternal tunnel from right to left under control of right-sided thoracoscopy. The plate was modeled according by individual deformation parameters chest. The analysis was carried out according to the following criteria: age, gender, type of deformity, Haller index, duration of surgery, intraoperative and early postoperative complications according by Clavien–Dindo classification. Results. The median age of patients was (13.8 ± 1.9) years, of which there were 65 (85.25 %) boys, 16 (19.75 %) girls. 48 (59.3 %) children were diagnosed with type I (symmetric) deformity, and 33 (40.7 %) with type II (asymmetric) according to the classification. The median Haller was (4.07 ± 0.62), which corresponds to 2–3 degrees. Differences in the degree of deformation in children of different sexes were not determined (р = 0.828). Impaired lung function was d iagnosed i n 55.55 % (n = 45), i mpaired h eart f unction — 40.74 % (n = 33). T he d uration of the o peration was on a verage (70.6 ± 15.4) minutes, from 50 to 110 minutes. Early postoperative complications were found in 5 (6.17 %) patients classified as grade I (mild) according to the Clavien–Dindo classification, which did not require additional medical or surgical correction. After the operation, the correction of chest deformation was on average (2.35 ± 0.22) according by Haller index, which was statistically significantly (р = 0.001) different from the initial level. Conclusions. The use of modified technology surgical correction of PE meets safety requirements and minimizes postoperative complications.

CAUSES OF PAIN IN THE MUSCLES OF THE LOWER EXTREMITIES IN CHILDREN WITH CEREBRAL PALSY

Oleksandr Danilov, Oleksandr Shulga, Oleksandr Kucheruk, Kateryna Bandrina — Tue, 08 Oct 2024 00:00:00 +0300

A high level of muscle spasticity in children with cerebral palsy is one of the causes of degenerative and dystrophic changes in tissues. Against the background of high spasticity, there is a violation of blood flow in the vessels of the lower extremities, which leads to changes in subfascial pressure and the formation of primary pain syndromes. The analysis of the literature shows the need to study the issues related to the mechanism of formation of changes in the muscles and determine the primary causes of pain. Objective. Тo study the mechanism of changes in the muscles of the lower extremities, as well as the primary causes of pain syndrome. Methods. The analysed indicators were obtained during the treatment of 40 patients with cerebral palsy, who were divided into 3 groups depending on the muscle tone disorder. Clinical and instrumental methods were used to examine patients. The data obtained were statistically processed with the determination of M ± m, the coefficient of reliability according to Student’s criteria. Results. According to the results of the study, high spasticity leads to impaired blood flow and increased subfascial pressure in the musculofascial sheaths. There is an inverse correlation between the increase in subfascial pressure, the diameter of the vessel lumen and blood flow velocity. This is one of the causes of degenerative and denervation changes in muscles and fascia. It was proved that the occurrence of primary pain in the lower extremities is caused by various etiological causes: tissue ischemia; increased subfascial pressure; narrowing of pathologically significant anatomical areas in which nerves lie; degenerative and dystrophic changes in the joints. Conclusions. The study found that the cause of changes in the muscles and fascia is a violation of blood flow, a change in subfascial pressure in the musculofascial cases of the lower extremities. The occurrence of pain in the lower extremities in children with cerebral palsy is multifactorial in nature and consists of myofascial, articular, and tunnel syndromes.

CHANGES IN THE CONTENT AND ACTIVITY OF MUSCLE PROTEINS AS A MARKER IN THE CASE OF EXPOSURE TO IONIZING RADIATION IN ANIMALS

Tue, 08 Oct 2024 00:00:00 +0300

Objective. To find out the specifics of muscle tissue contraction under the conditions of exposure to low doses of ionizing radiation in parents and their irradiated offspring by evaluating changes in the content of contractile proteins and ATPase activity of skeletal and cardiac muscles. Methods. Experimental studies were conducted on 50 rats. Animals were randomized as follows: group 1 — intact sexually mature rats; 2 — sexually mature animals irradiated with a dose of 1.0 Gy; group 3 — monthold rats obtained from intact individuals; group 4 — month-old rat pups obtained from parents irradiated with a dose of 1.0 Gy; group 5 — month-old rats obtained from animals irradiated with a dose of 1.0 Gy, which were irradiated at the same dose. The results. Muscle dysfunction in irradiated offspring and parents is manifested by a decrease in the content of contractile proteins, functional dysfunction of the actomyosin bridge, and a decrease in the ATPase activity of contractile proteins. Marked muscle dysfunctions during the post-radiation time period may be the reason for the formation of orthopedic pathology in a significant contingent of irradiated persons. Conclusions. The expression of muscle dysfunction in the offspring of irradiated animals, which were also exposed to ionizing radiation, is greater than the corresponding processes in their irradiated parents, which indicates the mediation of muscle dysfunction in the second generation of irradiated animals by epigenetic mechanisms. Marked muscle dysfunctions during the post-radiation time period may be the reason for the formation of orthopedic pathology in a significant contingent of irradiated persons

BIOCHEMICAL PARAMETERS OF THE BLOOD OF RATS OF DIFFERENT AGES AFTER FILLING THE METAPHYSEAL DEFECT OF THE FEMUR WITH ALLOGENEIC BONE IMPLANTS WITH LOCAL ADMINISTRATION OF BLOOD PLASMA ENRICHED WITH PLATELETS

Petro Vorontsov, Frieda Leontyeva, Vladyslav Tuliakov — Tue, 08 Oct 2024 00:00:00 +0300

A promising method of regenerative medicine is the saturation of allografts with platelet-rich plasma (PRP). Objective. To evaluate the course of metabolic processes after filling a hole defect in the distal metaphysis of the femur with allogeneic bone implants in conditions of additional local administration of allogeneic PRP. Methods. In the model of a hole defect in white rats with the filling of the defect with an allograft, as well as with additional local stimulation of PRP on the 7th day; on the 3rd and 7th days and on the 1st, 3rd and 7th days in blood serum, the content of glycoproteins (GP), chondroitin sulfates (CST), total protein (TP), calcium (Ca), activity alkaline phosphatase (AlP) and acid phosphatase (AcP). The results. 14 day. In the 3-month rats, under one stimulation, an increase in TP and Ca, a decrease in AcP was observed, with two stimulations there was a 1.11 times smaller GP, 1.13 times larger TP and 1.43 times Ca compared to those in rats without stimulation. During three stimulations, the GP was 1.24 times lower than that in animals without stimulation. In the 12-month rats in comparison with the data of rats without stimulation, 1.15 times higher GP, Ca, AlP activity, and 1.44 times more AcP were noted. 28 days of the 3-month rats for one injection exceeded the data of animals without stimulation by 1.34 times for GP, and were inferior to them by 1.31 times for AcP. In the 12-month rats, compared to these animals without stimulation, with three injections, a 1.19 times greater TP was noted. 90 d. In the 3-month rats for one injection showed 1.24 times less CST with 1.28 times lower AlP compared to data from rats without stimulation. 12-month rats exceeded the data of the group without stimulation by 1.43 times for AlP. Conclusions. In rats with an alloimplant (especially at 12 months), an increase in connective tissue formation markers and a decrease in LF activity were observed. Filling the defect with an alloimplant led to an increase in inflammation indicators and an increase in markers of bone tissue formation.

THE INFLUENCE OF THE CULTURE OF FIBROBLASTIC CELL ELEMENTS ON THE INDICATORS OF THE METABOLISM OF CONNECTIVE TISSUE IN EXPERIMENTAL ANIMALS

Tue, 08 Oct 2024 00:00:00 +0300

The number of patients with degenerative tendon disease affects millions of people both among athletes and the general population, causing significant socio-economic consequences. Despite the availability of various methods of conservative and surgical treatment, more than a third of patients experience constant pain. Objective. To study the indicators of the metabolism of connective tissue in animals with a model of degenerative damage to tendons against the background of the introduction of a culture of fibroblastic cell elements. Methods. Therefore, the development of methods for restoring the structure of tendons using cell cultures, in particular fibroblasts, will allow to optimize the course of reparative processes, reduce the risk of complications during surgical intervention and accelerate healing, and at the molecular level — to improve the structure of collagen fibers. Laboratory studies of biochemical markers of a tendon with a degenerative-dystrophic lesion and against the background of the introduction of cell culture can help in the differential diagnosis of its extracellular matrix. Results. The experimental data obtained by us indicate the presence of differences in the biochemical markers of tendons with degenerative-dystrophic lesions in rats 7, 21, and 45 days after the introduction of culture of fibroblastic cell elements. However, 45 days after the introduction of the culture of fibroblast cell elements, the normalization of metabolic processes in the extracellular matrix of connective tissue occurs, namely, the activity of collagenase and the concentration of protein-bound hydroxyproline approaches normal values. This indicates the predominance of the synthetic phase over the catabolic one in collagen metabolism. Conclusions. In this context, the introduction of culture of fibroblastic cell elements, as an alternative anti-inflammatory method, may provide another potential opportunity in the treatment of chronic degenerative-dystrophic lesions of the Achilles tendon.

STUDY OF THE POTENTIAL ANALGESIC PROPERTIES OF CARBON DIOXIDE FOR THE TREATMENT OF PAIN SYNDROME IN CASE OF OSTEOARTHRITIS

Viktor Shtroblia, Ruslan Lutsenko — Tue, 08 Oct 2024 00:00:00 +0300

Pain syndrome is a serious global problem that causes and complicates a number of diseases, the main symptom of which is joint pain. One of them is osteoarthritis (OA). Traditional methods of treating OA often have limited efficacy and can cause side effects, so it is important to study new approaches, such as carboxytherapy (use of carbon dioxide). Objective. To investigate the analgesic effect of carbon dioxide (CO2) and its combined use with other agents. Methods. The efficacy of carbon dioxide injections used alone and in combination with other drugs was studied in a formalin model of inflammation in rats. Results. The latent periods of phases I and II increased significantly in the experimental groups, especially in groups V, VI and VII (p < 0.001), indicating a delay in pain reactions. The duration of pain phase I was significantly shorter in the groups receiving CO2 compared to the control group (p < 0.001). The shortest duration was observed in group V, where it decreased by 1.77 minutes. The duration of pain phase II was also significantly shorter in groups V, VI, and VII treated with CO2 compared to group II (p < 0.001). The difference ranged from 7.49 to 12.54 minutes. The number of pain reactions after phase I decreased by 13.25– 16.1 points in the groups receiving CO2 compared to the control group. The data obtained indicate that CO2 significantly increases the duration of latent periods of pain (by 55–65 %), reduces the duration of its phases (by 40–50 %) and reduces the intensity of pain reactions (by 40–50 %) in rats compared to control pathology. The most pronounced effect was observed with the combined use of CO2 with sodium diclofenac or chondroitin sulfate. Conclusions. The results of the study expand the understanding of the analgesic effect of CO2 on the formalin model of inflammation. The use of CO2 significantly reduced the duration of both phases of the pain reaction and reduced the number of painful manifestations, which confirms the prospects of its use as an additional, and in some cases the main means of reducing pain and inflammation.

ACADEMICIAN KORZH O.O. IS AN OUTSTANDING SCIENTIST OF THE XX CENTURY, FOUNDER OF A NEW STAGE OF DEVELOPMENT OF ORTHOPEDICS AND TRAUMATOLOGY IN UKRAINE (TO THE 100TH ANNIVERSARY OF HIS BIRTH)

Tue, 08 Oct 2024 00:00:00 +0300

The article is dedicated to academician Korzh Oleksii Oleksandrovych.

METHODS OF PERCUTANEOUSFIXATION OF FRAGMENTS IN SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN AND ADOLESCENTS

Tue, 08 Oct 2024 00:00:00 +0300

The aim of this study is to conduct a meta-analysis and evaluate the clinical efficacy and safety of crossed and lateral fixation of fragments in supracondylar humerus fractures in children and adolescents. Methods. A comprehensive literature search was conducted in the PubMed and EMBASE databases from 2015 to December 2023 using the following search terms: "supracondylar fractures of distal humerus in pediatric patients", "treatment", "methods of fixation", "pinning configuration", "biomechanical analysis of pin placement". According to the inclusion and exclusion criteria, the literature sources of anatomic-biomechanical and clinical studies related to the use of crossed and lateral fixation of fragments in the case of supracondylar fractures of the humerus in children and adolescents were selected and analyzed. The review was prepared in accordance with the recommendations of the "Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines." Results. A comparison of results from experimental studies investigating the degree of stabilization achieved in the crossed and lateral configurations of fixation structures reveals conflicting conclusions due to the heterogeneity of designs implemented. The principal limitation of lateral fixation is the increased risk of failure of fixation. The outcomes of clinical trials (Flynn criteria) demonstrate that both types of fracture fixation yield equivalent clinical outcomes. One disadvantage of crossed fixation is the risk of iatrogenic ulnar nerve damage, while another disadvantage is the increased complexity of the surgical technique. Conclusions. The results of anatomical and biomechanical studies indicate that cross-fixation provides more rigid fixation of fragments in supracondylar humerus fractures in children and adolescents. Nevertheless, clinical outcomes based on radiological and functional data (including Flynn's score) demonstrate no significant distinction between the two types of fixation configurations. However, they do indicate a notable risk of iatrogenic ulnar nerve damage in cross fixation, which justifies the necessity to utilise a mini-open technique in the medial fixation construct.

OSSEOINTEGRATIVE PROSTHETICS: OPPORTUNITIES, CHALLENGES, AND PROSPECTS FOR ITS APPLICATION IN THE REHABILITATION OF PATIENTS WITH AMPUTATED LIMBS (LITERATURE REVIEW)

Tue, 08 Oct 2024 00:00:00 +0300

Rehabilitation of patients with amputated limbs is a pressing medical and social issue in modern society. A novel method for partial restoration of limb function is osseointegrative prosthetics. Its main advantage lies in the fact that the implant allows mechanical loads and forces to be transmitted directly to the bone, whereas in traditional prostheses, they mainly act on soft tissues. Despite nearly 30 years of experience with osseointegrative implants globally, these technologies have not yet been implemented in either scientific or clinical practice in Ukraine. Objective. To conduct a literature review of the global practical experience with the use of osseointegrative prosthetics in patients with amputations and to identify its main features, advantages, and disadvantages. Methods. The information search was performed in the bibliographic databases PubMed, Scopus, and Google Scholar. Results. The analysis of literature sources allowed us to distinguish the main types of osseointegrative implants, which differ in terms of design, materials, and surgical techniques: either single-stage or two-stage procedures, and fixation by threading or press-fitting. The rehabilitation period ranges from 6 months to 2 years. Within the first two years, certain complications such as bone infections and skin inflammation should be expected. Hфowever, most of these pathological conditions can be effectively managed. Conclusions. Successful fixation of osseointegrative implants requires optimizing the patient’s bone, the prosthetic surfaces, and the ‘skin-implant’ interface. The implementation of these technologies requires multidisciplinary teams of specialists, including physicians, engineers, and rehabilitation experts. Osseointegrative implants significantly enhance patients’ functional abilities and quality of life, opening up greater opportunities for the use of bionic and robotic prosthetics.

DIRECT ANTERIOR SURGICAL APPROACH FOR TOTAL HIP ARTHROPLASTY AS AN ALTERNATIVE TO THE DIRECT LATERAL APPROACH

Dmytro Sereda — Tue, 08 Oct 2024 00:00:00 +0300

The frequency of total hip arthroplasty (THA) is continuously increasing. Currently, efforts are underway to improve the efficiency of this surgery, making the choice of surgical approach a key factor in its success. The direct anterior approach is gaining popularity due to faster patient recovery, but its advantages and disadvantages compared to the direct lateral approach are not yet fully understood. Objective. To compare the outcomes of the direct anterior and direct lateral approaches in primary total hip arthroplasty, as well as to identify ways to improve the results of THA performed using the direct anterior approach. Methods. A literature search was conducted in three bibliographic databases: PubMed, Scopus, and Web of Science. Results. The direct anterior approach has been found to reduce postoperative pain, blood loss, the likelihood of periprosthetic infection, and hospital stay duration. However, there is an increased risk of dislocation and revision surgery. Several randomized controlled trials have been cited, studying issues related to effective pain management, wound healing, prevention of lateral femoral cutaneous nerve injury, blood loss, prosthetic stem design, specific surgical techniques, equipment selection, early mobilization after THA, and the use of modern software for THA planning. Conclusions. The literature review revealed that patients who underwent THA via the direct anterior approach experienced less postoperative pain. The shorter incision associated with this approach also reduces intraoperative blood loss and periprosthetic infection rates. However, the risk of dislocation and subsequent revision surgeries increases, as does the incidence of nerve paralysis due to lateral femoral cutaneous nerve injury.