Тотальное эндопротезирование коленных и тазобедренных суставов при ревматоидном артрите: тенденция настоящего времени

Тотальное эндопротезирование (ТЭ) – хирургическая операция, широко используемая при тяжелом деструктивном поражении суставов. ТЭ коленного (КС) и тазобедренного (ТБС) суставов занимает важное место в комплексном лечении ревматических заболеваний, таких как ревматоидный артрит (РА) и остеоартрит (ОА), и позволяет значительно уменьшить боли и улучшить функциональный статус у пациентов с выраженными структурными изменениями суставов в случае неэффективности консервативной терапии. В последние годы в связи с развитием современной концепции активного лечения РА (treat-to-target) и внедрением новых классов базисных противовоспалительных препаратов, таких как генно-инженерные биологические препараты и ингибиторы Янус-киназ, потребность в ТЭ крупных суставов начала снижаться. В то же время старение популяции, рост числа больных ОА и отсутствие общепризнанной патогенетической терапии данного заболевания определяют увеличение числа ТЭ КС и ТБС при ОА. В настоящем обзоре представлена многолетняя динамика проведения ТЭ КС и ТБС по данным национальных регистров разных стран. Также рассмотрены вопросы риска осложнений при ТЭ КС и ТБС у больных РА и ОА, современные рекомендации по проведению противоревматической терапии при РА в периоперационном периоде.

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