Hip replacement

Endoprosthetics is called surgical intervention, aimed at replacing the injured as a result of illness or injury of the hip joint by an artificial one. Sometimes such an operation is the only way by which you can return the patient the opportunity to move.

If the operation is carried out by the elderly, the artificial joint in most cases serves them all life. If it is necessary to replace the hip joint, a person younger than 60 years old should take into account that repeated surgery may be required.

Indications for surgical intervention for hip joint disease

Joint replacement- a complex procedure that requires a long time for rehabilitation, so its appointment requires strict testimony.

To diseases in which a hip replacement is required, it is possible to refer:

• rheumatoid arthritis;
• defeat of the hip joint with Bekhterev's disease;
• fracture of the femoral neck;
• hip joint trauma, which can not be cured by other methods;
• long-term chronic diseases of a degenerative-dystrophic nature - deforming arthrosis (coxarthrosis), arthritis;
• benign or malignant neoplasm of the joint;
• aseptic necrosis of the head of the femur.

When appointing an operation, the following are considered:

• stage of the disease,
• intensity and duration of painful attacks,
• the results of conservative therapy,
• The need for additional support during movement,
• reduction of motor activity in the joint,
• possible prospects for other surgical techniques.

The main contraindications for endoprosthetics

Among the absolute contraindications to surgery for the replacement of the hip joint can be called:

• decompensated diseases of the cardiovascular and respiratory system;
• not cured focus of purulent infection;
• mental illness or disorders of neuromuscular activity;
• infectious process, localized in the region of the hip joint;
• a young age, which assumes incomplete formation of the structure of the skeleton;
• thromboembolism or thrombophlebitis of the veins of the lower limb in the active stage,
• presence of polyallergy;
• the inability to carry out movements in the patient,
• in the femur there is no cerebral canal.

Relative contraindications are:

• the presence of hormonal osteopathy,
• acute liver failure,
• third degree of obesity.

Types of endoprostheses

Material for the endoprosthesis can be metal, especially strong ceramic or plastic.

Selection of the prosthesis is carried out individually. To date, there are more than sixty variations (modifications) of these designs. You can classify them depending on the procedure for performing the operation and on the method of attachment to the bone.

Depending on the technique of performing an operation, it is possible to distinguish:

1. Single-pole endoprostheses, used if necessary to replace the head of the femur (hemiarthroplasty).
2. Bipolar prostheses- when the acetabulum and the bone head (total endoprosthetics) are in need of replacement.

Depending on the method of attaching the prosthesis to the bone, we can distinguish:

1. Non-cement fixation prostheses- fastening is carried out when the patient's bone tissue germinates into the structure of the endoprosthesis.
2. Combined or hybrid endoprosthesesprovide fastening of the cup with the help of cementless method, and legs with special bone cement.
3. Prostheses of cement fixation- fixation of both parts of the endoprosthesis is carried out with the help of cement.

Modern hip joint prostheses should have the following characteristics:

• provide a large number of movements;
• protect the bone tissue of the acetabulum;
• have a head diameter close to natural;
• to have high abrasion resistance;
• Allow the doctor during a surgery to make a small incision or change the length of the patient's limb.

Preparation for the operation and its conduct

During the preparation for an operation, it is necessary:

• to hand over analyzes,
• make fresh X-ray images of the joint in two projections,
• undergo an examination with a therapist,
• cure all diseases in acute form and chronically current infectious diseases,
  pass the examination at the dentist and eliminate the problems of the oral cavity,
• if the patient has excess weight, an endocrinologist and nutritionist consultation is necessary (excess body weight creates an increased load on the hip joint, which can lead to the development of postoperative complications),
• In advance, be concerned about purchasing crutches for the rehabilitation period.

Conducting surgical intervention

Hospitalization of a person occurs a day before the proposed operation, on the first day, an anesthesiologist's consultation is needed to choose the method of anesthesia.

Stages of the operation

The operation consists of the following steps:

1. After anesthesia, a cut and removal of the damaged joint surfaces is performed.
2. Fixation of endoprostheses (sometimes, in addition to the prescribed method of fixation, special screws are used).
3. Orthopedic examination of a new joint.
4. Stitching the wound (to drain the exudate and blood drainage is left).

Organizational matters of the operation

Endoprosthetics - a rather expensive surgical intervention (its cost depends on the clinic and can be from 70 to 200 thousand rubles).

To carry out this operation, you can use two funding channels:

1. Personal resources of the patient- the person himself pays the cost of the endoprosthesis and the drugs used during the operation and the post-operation period.
2. Quota operation(high-tech medical care) - is carried out at the expense of the state, which is buying the prosthesis for the patient. To use the quota, it is necessary to collect a package of documents and stand in line, contacting the health department at the place of registration. From the time of submission of documents to conducting a free operation, it can take from 6 to 12 months.

Possible complications in hip replacement

Complications that develop due to a doctor's mistake during surgery include:

• fracture of bone structures during the operation;
• violation of the sensitivity or innervation of the extremity due to the intersection of the neural bundle.

Among the other postoperative complications, we can distinguish:

• infectious process that occurs after surgery in the wound or in the artificial joint;
• development of pain syndrome (there are pains in the back, leg or pelvic area);
• dislocation of the endoprosthesis head;
• loosening of artificial prosthetic structures.

Features of the rehabilitation period

When replacing the hip joint, the patient is discharged after the removal of stitches (on days 12-14).The joint can be developed as early as the second day after surgery:first just sit on the bed, then go up under the supervision of the staff of the clinic, and by the time of discharge, a person can usually walk slowly, leaning on a cane.

To extend the life of joints, you must follow simple rules:

• when getting up to watch, so that there is no turning of the foot inside,
• At least 7-8 days after surgery wear compression stockings,
• , -2 months after the operation you can walk only on crutches, walking stick or walker,
• It is strictly forbidden to lift or carry objects weighing more than 10 kg,
• follow the body weight, not allowing it to increase,
• you can not fall, climb the stairs or through the trees,
• You can not make sharp flops with your foot or lay your foot on your leg while sitting.

Re-replacement of the joint (revision endoprosthetics) is required if the joint has become unusable, infection or destruction of bone tissue occurred at the site of fixation of the endoprosthesis. After a second operation, the rehabilitation period will take at least 10-12 months, during which the person should be observed by an orthopedic doctor.