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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">rsj</journal-id><journal-title-group><journal-title xml:lang="ru">Российский хирургический журнал</journal-title><trans-title-group xml:lang="en"><trans-title>Russian surgical journal</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">3034-7270</issn><issn pub-type="epub">3033-5604</issn><publisher><publisher-name>Фонд Алмазова</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.18705/3034-7270-2026-2-3-268-277</article-id><article-id custom-type="elpub" pub-id-type="custom">rsj-159</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ТРАВМАТОЛОГИЯ И ОРТОПЕДИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>TRAUMOTOLOGY AND ORTHOPEDICS</subject></subj-group></article-categories><title-group><article-title>Хирургическое лечение обширного дефекта вертлужной впадины у пациентки с асептической нестабильностью тотального эндопротеза тазобедренного сустава: клиническое наблюдение и современный обзор литературы</article-title><trans-title-group xml:lang="en"><trans-title>Surgical treatment of an extensive acetabular defect in a patient with aseptic instability of a total hip arthroplasty: a clinical case and updated literature review</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6736-9772</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Загородний</surname><given-names>Н. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Zagorodniy</surname><given-names>N. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Загородний Николай Васильевич – д-р мед. наук, профессор, академик РАН</p><p>Москва</p></bio><bio xml:lang="en"><p>Zagorodniy Nikolay V. – Doctor of Medical Sciences, Professor, Academician of RAS, traumatologist-orthopedist</p><p>Moscow</p></bio><email xlink:type="simple">zagorodniy@sustav.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1314-2887</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Назаренко</surname><given-names>А. Г.</given-names></name><name name-style="western" xml:lang="en"><surname>Nazarenko</surname><given-names>A. G.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Назаренко Антон Герасимович – д-р мед. наук, профессор РАН, чл.-кор. РАН</p><p>Москва</p></bio><bio xml:lang="en"><p>Nazarenko Anton G. – Doctor of Medical Sciences, Professor RAS, Corresponding Member of RAS</p><p>Moscow</p></bio><email xlink:type="simple">NazarenkoAG@cito.priorov.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8434-1915</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Каграманов</surname><given-names>С. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Kagramanov</surname><given-names>S. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Каграманов Сергей Владимирович – д-р мед. наук, врач травматолог-ортопед</p><p>Москва</p></bio><bio xml:lang="en"><p>Kagramanov Sergey V. – Doctor of Medical Sciences, Traumatologist‑Orthopedis</p><p>Moscow</p></bio><email xlink:type="simple">kagramanov2001@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6909-6624</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Алексанян</surname><given-names>О. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Aleksanyan</surname><given-names>O. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Алексанян Оваким Аргамович – канд. мед. наук, врач травматолог-ортопед</p><p>Москва</p></bio><bio xml:lang="en"><p>Aleksanyan Hovakim A. – Candidate of Medical Sciences, traumatologist-orthopedist</p><p>Moscow</p></bio><email xlink:type="simple">Hovakim1992@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-6457-3156</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Чрагян</surname><given-names>Г. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Chragyan</surname><given-names>G. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Чрагян Гамлет Ашотович – канд. мед. наук, врач травматолог-ортопед</p><p>Москва</p></bio><bio xml:lang="en"><p>Chragyan Gamlet A. – Candidate of Medical Sciences, Traumatologist-Orthopedist</p><p>Moscow</p></bio><email xlink:type="simple">chragyan@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0007-6205-4759</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Фроликов</surname><given-names>И. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Frolikov</surname><given-names>I. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Фроликов Илья Вадимович – врач-ординатор</p><p>Москва</p></bio><bio xml:lang="en"><p>Frolikov Ilya V. – Resident physician</p><p>Moscow</p></bio><email xlink:type="simple">feat007@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Абдуллин</surname><given-names>М. Р.</given-names></name><name name-style="western" xml:lang="en"><surname>Abdullin</surname><given-names>M. R.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Абдуллин Марат Ренатович – врач-ординатор</p><p>Москва</p></bio><bio xml:lang="en"><p>Abdullin Marat R. – Resident physician</p><p>Moscow</p></bio><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр травматологии и ортопедии имени Н.Н. Приорова» Министерства здравоохранения Российской Федерации</institution><country>Россия</country></aff><aff xml:lang="en"><institution>N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2026</year></pub-date><pub-date pub-type="epub"><day>12</day><month>09</month><year>2026</year></pub-date><volume>2</volume><issue>3</issue><fpage>268</fpage><lpage>277</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Загородний Н.В., Назаренко А.Г., Каграманов С.В., Алексанян О.А., Чрагян Г.А., Фроликов И.В., Абдуллин М.Р., 2026</copyright-statement><copyright-year>2026</copyright-year><copyright-holder xml:lang="ru">Загородний Н.В., Назаренко А.Г., Каграманов С.В., Алексанян О.А., Чрагян Г.А., Фроликов И.В., Абдуллин М.Р.</copyright-holder><copyright-holder xml:lang="en">Zagorodniy N.V., Nazarenko A.G., Kagramanov S.V., Aleksanyan O.A., Chragyan G.A., Frolikov I.V., Abdullin M.R.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://rsj.elpub.ru/jour/article/view/159">https://rsj.elpub.ru/jour/article/view/159</self-uri><abstract><p>Цель исследования – на клиническом примере продемонстрировать возможности одноэтапного ревизионного эндопротезирования тазобедренного сустава с использованием индивидуальной 3D-печатной вертлужной конструкции при обширном дефекте вертлужной впадины типа pelvic discontinuity и провести анализ современной литературы по данной проблеме. Представлено клиническое наблюдение пациентки 45 лет с многократными операциями на обоих тазобедренных суставах в анамнезе (реконструктивные вмешательства в детстве, первичное и повторные ревизионные эндопротезирования 1991, 1998, 2001 и 2012 гг.), у которой в 2019 г. диагностирована асептическая нестабильность тотального эндопротеза правого тазобедренного сустава с обширным дефектом вертлужной впадины типа IIIB по W.G. Paprosky. Выполнено одноэтапное ревизионное эндопротезирование с изготовленным по данным компьютерной томографии индивидуальным трехфланцевым вертлужным компонентом, напечатанным из титанового порошка по технологии прямого лазерного спекания металла (DMLS). Показатель HHS увеличился с 21 балла до операции до 82 баллов через 6 мес после операции; показатель WOMAC снизился с 73 до 15 баллов за тот же период. Осложнений в раннем послеоперационном периоде не отмечено; сохранялась хромота, связанная с рубцовой перестройкой и атрофией ягодичных мышц. Данные обновленного анализа литературы 2018–2026 гг. подтверждают, что применение индивидуальных аддитивно изготовленных конструкций остается эффективным и обоснованным методом восстановления опороспособности конечности и функции сустава при обширных дефектах вертлужной впадины и pelvic discontinuity, хотя сохраняется значимый риск вывиха, повреждения нервов и инфекционных осложнений, что требует дальнейшего совершенствования технологии планирования, фиксации и профилактики нестабильности. </p></abstract><trans-abstract xml:lang="en"><p>The objective of this study was to demonstrate, using a clinical example, the possibility of one-stage revision hip arthroplasty with a custom 3D-printed acetabular implant for an extensive acetabular defect with pelvic discontinuity, and to review recent literature on this topic. We report a 45-year-old female patient with multiple prior hip surgeries (reconstructive procedures in childhood; primary and revision arthroplasties in 1991, 1998, 2001 and 2012) who presented in 2019 with aseptic instability of the right total hip arthroplasty and a Paprosky type IIIB acetabular defect. One-stage revision arthroplasty was performed using a custom triflange acetabular component designed from CT data and manufactured from titanium powder using direct metal laser sintering (DMLS). The Harris Hip Score improved from 21 points preoperatively to 82 points at 6 months; the WOMAC score decreased from 73 to 15 points over the same period. No early postoperative complications occurred; mild residual limp related to scarring and gluteal muscle atrophy persisted. An updated review of the 2018–2026 literature confirms that custom additively manufactured implants remain an effective option for restoring limb support and hip function in extensive acetabular defects and pelvic discontinuity, although dislocation, nerve injury and infection remain relevant risks requiring further refinement of planning, fixation and stability strategies. </p></trans-abstract><kwd-group xml:lang="ru"><kwd>тазобедренный сустав</kwd><kwd>ревизионное эндопротезирование</kwd><kwd>индивидуальная конструкция</kwd><kwd>3D-печать</kwd><kwd>pelvic discontinuity</kwd></kwd-group><kwd-group xml:lang="en"><kwd>hip joint</kwd><kwd>revision arthroplasty</kwd><kwd>custom implant</kwd><kwd>3D printing</kwd><kwd>pelvic discontinuity</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Bains SS, Dubin J, Salib CG, et al. 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