Hip joint: endoprosthetics and further recovery

Joints that hurt and lack mobility, are a hindrance in the performance of everyday activities, deprive them of the opportunity to lead a normal life. Especially hard if the hip is struck. Endoprosthetics of the joints help restore lost limb function, being often the only way out for the patient. Indications for the operation are more than 300 thousand people a year.

The first and main sign of joint disease is pain. At first, the pain is of low intensity, but in the future, with the progression of the ailment, the pain intensifies, becoming permanent companions of man.

Then comes the turn of the disorder of the affected limb. The disease tends to progress, sometimes leading to complete immobility. In such patients, conservative treatment is no longer able to help save the affected hip joint.

Endoprosthetics of the hip joint is currently one of the most modern methods of surgical care for the lesions of this joint. During this operation, the affected tissues entering the hip joint change to artificially created prostheses.

Structure and work of the hip joints

The hip joint is one of the largest bone articulations in the human body. The loads tested by him during the life of a person are very great, since it serves to connect the lower limb and pelvis.

Composition of the hip joint:

• Head of the thigh - the upper end of the thigh, which has a spherical shape;
• Acetabulum - a funnel-like deepening of the pelvic bones, in which the head of the femur is fixed;
• Cartilage of the joint - a tissue that has a gel-like lubricant that facilitates the movement of parts of the joint articulation;
• Synovial (intraarticular) fluid - a special mass of a jelly-like consistency that nourishes the cartilage and helps to soften the friction of the joint surfaces;
• The joint capsule and the ligamentous apparatus is a connective tissue that serves to retain the articular surfaces and ensure the stability of the joint.

Muscles with tendons, fastened in the region of the hip joint, with their contractions provide movement in it. In a healthy state, the hip joint is very mobile, having the ability to move in any plane and direction. He successfully copes with the provision of walking and support functions.

Why do I need endoprosthetics?

That the doctor has put before the patient a question on replacement of its hip joint with a prosthesis the powerful reasons are necessary. The operation is appointed if the damage to the joints has reached such a degree that the person constantly feels unbearable pain, or his affected limb is unable to perform even elementary movements. In these situations, when the hip is struck, endoprosthetics can become a way out.

Among the ailments that can cause joint damage, requiring surgery, you can call:

• Deforming bilateral osteoarthritis in case of 2 and 3 severity;
• Deforming osteoarthritis of the third degree with deformation of one of the joints;
• Ankylosis of the hip joints, which occurs with rheumatoid arthritis and as a result of Bekhterev's disease;
• Aseptic necrosis of the head of the femur as a result of injuries and with disturbed blood circulation;
• Trauma to the head and neck of the femur in the form of a fracture in the elderly;
• Tumors in the ankle, in need of surgical treatment.

Replacement of the hip joint is advisable only in the event of a complete loss of the possibility of motor activity and walking. The final decision on the operation is made taking into account all factors.

Contraindications to surgical intervention

There are often cases when even people who are in urgent need of hip replacement can not go to surgery because of contraindications.

The most common restrictions include:

• A situation where the patient will not be able to move independently, even if the operation is performed;
• Chronic disease in the decompensation stage (heart failure, cerebral circulation disorders, liver failure), when the operation is able to aggravate the existing problems;
• Chronic lung damage, causing respiratory and ventilation insufficiency (emphysema, asthma);
• Various inflammations of bones, skin or soft tissues in the region of the hip joint;
• Osteoporosis, leading to inadequate bone strength and the risk of breaking a bone during an ordinary walk after surgery;
• Pathology, in which there is no bone marrow channel in the femur.

Classification of endoprostheses

The endoprosthesis replacing the affected hip joint should have sufficient strength, it must be securely fixed and have an inertness to the tissues of the patient's body. Modern endoprostheses, made of polymers, ceramics and metal alloys, meet all the necessary requirements. Externally, the endoprosthesis is similar to the human hip joint.

Its details:

• Cup endoprosthesis. This part replaces the acetabulum of the pelvic joint. The material of its manufacture is ceramics. However, there are also cups of polymers.
• The head of the prosthesis. A metal component of a spherical shape with a polymer coating. This ensures softness of sliding when the head rotates in the endoprosthesis cup when performing various movements with the limb.
• Leg of the prosthesis. It experiences the greatest loads, therefore it is always made of metal. Is the replacement of the neck and upper third of the femur.

Also, endoprostheses are divided into single-pole and bipolar. In single-pole prostheses the patient retains his acetabular cavity, prosthetics of only the head and neck of the thigh. This is an outdated version of the prosthesis, which was widely used before. Their use was characterized by high frequency of destruction of the acetabulum, and they were no longer used in modern orthopedic practice.

Bipolar endoprostheses are called total. They produce total hip arthroplasty. There are all three of the above details of the prosthesis.

The service life of the hip endoprosthesis is determined by the quality of the materials that served to make it. The strongest metal endoprostheses serve up to 20 years. However, the optimal result for a combination of service life and motor activity is provided by a combination of metal-polymer-ceramics.

Preparatory activities

All patients who need prosthetics should be examined for the condition of the hip joint (ultrasound, MRI, X-ray) to exclude all potential contraindications.

No special training is required for the operation. In the absence of contraindications, the date of the operation is determined. In the morning on the day of surgery, the skin is shaved in the region of the hip joint. Food and drink are prohibited.

Operation process

The patient is placed on the operating table, where he is anesthetized. The method of anesthesia is coordinated by the anesthesiologist and the patient. The duration of the operation can reach 5 hours in complicated cases. Therefore, the best option is either spinal anesthesia or full anesthesia. The first method of anesthesia does less harm, therefore it is better to appoint it to the elderly.

Upon completion of the anesthesia, the doctor will use the incision to arrange access to the hip joint. The required incision is about 20 cm. The capsule of the joint is opened and a femoral head is displayed, which is subjected to resection.

The modeling of bone takes place in the form of an endoprosthesis. Fixation of the prosthesis occurs most often with the help of cement. Further from the surface of the acetabulum , the cartilage is removed by the drill, where the endoprosthesis cup is then placed.

Possible complications

The operation of hip replacement is considered a complex surgical intervention.

It can lead to complications:

• bleeding;
• Thrombus formation in the veins of the lower extremities;
• Suppuration of the endoprosthesis and postoperative wound;
• hematoma;
• Rejection of the endoprosthesis;
• Complications of the cardiovascular system.

Careful preparation of the operation minimizes the risk of complications.

Operation results

According to statistics, on the endoprosthetics of the hip joint patients' reviews are mostly good. Patients are satisfied with the results of the operation. When performing surgery in persons of relatively young age without concomitant diseases, the function of the hip joint is restored in full. A person can walk and even exercise, without overloading the prosthesis. Sports classes are contraindicated.

There are also unsatisfactory results after the operation of hip arthroplasty. Most often they happen in old age, if there are concomitant pathologies. In 20% of patients who underwent endoprosthetics of the hip joint, the patients' feedback shows disappointment with the results of the operation.

Recovery after surgery

Rehabilitation of patients should start immediately after surgery. These are exercises after hip arthroplasty, and respiratory gymnastics. The limb that has undergone prosthetics should be kept at rest, but it is necessary to try to perform minimal muscle contractions after hip replacement has been performed. Rehabilitation should obey the main rule - you need to consistently increase the load.

First day after surgery

Most patients have to spend them in the intensive care unit. It is best to monitor the body's basic indicators, reacting instantly to all negative changes. At the end of several hours after the operation a person can already spend time in a sitting position, lowering the lower leg downwards.

The operated hip joint is not allowed to bend more than 90 °. This can disrupt its design and fixation in the bone. Adopting a sitting position is best under the supervision of medical professionals at the clinic or family. They will help in moving the sick limb and will provide first aid if dizziness occurs.

Getting up from the bed

Several days to get out of bed alone after the operation should not be. To rely on a healthy limb, without using ancillary devices, is prohibited for several weeks. Auxiliary devices can serve as walking sticks or crutches. With a satisfactory condition of the patient after such surgery as hip arthroplasty, rehabilitation allows using the help to get up the very next day, although most patients are not yet ready to do so.

Walking

To go to the patient is allowed on the 3rd day after the end of the operation. At the same time, all requirements for moving to standing position must be observed. It is necessary to move the operated limb with your hands or a healthy leg before you can be hung from the bed. You can get up on the basis of crutches and a healthy leg. Any attempts to rely on a sick leg are prohibited within a month of the operation, so it must be in a suspended state. Use crutches during walking is best not less than three months.

With a successful course of rehabilitation period, you can go to the cane for support. It is possible to lean on a sick leg in a month, but not transferring to it the entire weight of the body. To begin exercises after endoprosthetics of a hip joint it is necessary from branch of a leg or foot to the party or side with returning back and its or her raising and lowering in standing position. Load the operated leg for two months with a load not exceeding half the body weight of the patient. You can begin to walk fully without improvised means after 4-6 months from the operation. Loads should increase slowly and gradually.

Food

The most important component of a patient's recovery is proper nutrition. In the diet should be a lot of protein, micronutrients and vitamins. Do not stick to a too high-calorie diet, because patients can not actively move. Unutilized energy in this case can lead to weight gain, which will delay recovery. Do not show products from baking, fried and fatty foods, smoked products. Fish, lean meat, vegetables and fruits, cereals, eggs are allowed. Under no circumstances should you drink alcoholic beverages, coffee and tea.

Time of treatment and rehabilitation

Treatment in the clinic lasts 2-3 weeks. At the same time, the wound healing process is controlled. Usually seams are removed after 12 days. The rest of the stay in the medical institution the patient and his relatives are trained in the simplest rehabilitation skills of the operated leg. After 3 months after the operation, the radiograph of the hip joint is performed. It helps to assess the success of the operation and fixation of the endoprosthesis.

After the patient has been discharged from the medical institution, a consultation with a rehabilitation doctor can help a lot in further rehabilitation, which will help to make an individual plan for rehabilitation activities. This will help make a safer and less prolonged recovery period. In most patients, a return to active life occurs six months after the operation. Before final rehabilitation it is recommended to minimize the load of the limb, which has undergone prosthetic repair. Hip joint, endoprosthetics which was successful, can serve its owner for a long time.

Where to operate

Best of all, such operations are conducted abroad. The clinics of Israel and Germany, which specialize in the implementation of such interventions, have become very popular. However, the cost of endoprosthetics of the hip joint in such clinics is very high. A reasonable alternative, if for any reason it is impossible to perform an operation abroad, is hip replacement in Moscow. Russian physicians have made great progress in the field of endoprosthetics lately, having made at least 20,000 times a hip joint endoprosthetics. The price of this operation in our country is much less than in foreign clinics, and is 38,000 rubles.