Joints that hurt and lack mobility interfere with daily activities and make it impossible to lead a normal life. It is especially difficult if the hip joint is affected. Joint arthroplasty helps to restore the lost function of the limb, often being the only way out for the patient. More than 300 thousand people a year have indications for this operation.
The first and main sign of joint disease is pain. At first, the pains are of low intensity, but later, with the progression of the disease, the pains intensify, becoming constant companions of a person.
Next comes the turn of dysfunction of the affected limb. The disease tends to progress, sometimes leading to complete immobilization. For such patients, conservative treatment is no longer able to help save the affected hip joint.
Hip arthroplasty is currently one of the most modern methodssurgical care for lesions of this joint. During such an operation, the affected tissues that make up the hip joint are replaced with artificially created prostheses.
Structure and function of the hip joints
The hip joint is one of the largest bone joints in the human body. The loads it experiences during a person's life are very high, since it serves to connect the lower limb and the pelvis.
Composition of the hip joint:
- femoral head - the upper end of the thigh, having a spherical shape;
- acetabulum - a funnel-shaped depression of the pelvic bones, in which the head of the femur is fixed;
- articular cartilage is a tissue that has a jelly-like lubricant that facilitates the movement of parts of the articular joint;
- synovial (intra-articular) fluid - a special mass of jelly-like consistency that nourishes cartilage and helps mitigate friction of articular surfaces;
- joint capsule and ligamentous apparatus - connective tissue that serves to hold the articular surfaces and ensure joint stability.
Muscles with tendons attached in the area of the hip joint provide movement in it with their contractions. In a he althy state, the hip joint is highly mobile, being able to move in any plane and direction. He successfully copes with providing the functions of walking and support.
Why is arthroplasty necessary?
Tothe doctor raised the question of replacing his hip joint with a prosthesis before the patient, there are good reasons. The operation is prescribed if the damage to the components of the joint has reached such an extent that the person constantly feels unbearable pain, or his affected limb is not able to perform even elementary movements. In these situations, when the hip joint is affected, arthroplasty can be a way out.
Among the ailments that can cause joint damage requiring surgery are:
- deforming bilateral osteoarthritis in cases of severity 2 and 3 of the disease;
- deforming osteoarthritis of the 3rd degree with deformity of one of the joints;
- ankylosis of the hip joints that occurs with rheumatoid arthritis and due to Bechterew's disease;
- aseptic necrosis of the femoral head as a result of trauma and impaired circulation;
- injuries to the head and neck of the femur in the form of a fracture in the elderly;
- tumors in the ankle area requiring surgical treatment.
Hip replacement is advisable only in case of a complete loss of the ability to move and walk. The final decision on the operation is made taking into account all factors.
Contraindications for surgery
It is not uncommon for people who are in dire need of a hip arthroplasty to be unable to undergo surgery due to contraindications.
The most common restrictions include:
- situations when the patient will not be able to move independently even if the operation is performed;
- chronic disease in the decompensation stage (heart failure, cerebrovascular accident, liver failure), when surgery can aggravate existing problems;
- chronic lung disease causing respiratory and ventilatory failure (emphysema, asthma);
- various inflammation of the bones, skin or soft tissues in the area of the hip joint;
- osteoporosis leading to insufficient bone strength and the risk of breaking a bone during normal walking after surgery;
- pathologies in which there is no medullary canal in the femur.
Classification of endoprostheses
The endoprosthesis replacing the affected hip joint must have sufficient strength, it must be securely fixed and have inertness to the tissues of the patient's body. Modern endoprostheses made of polymers, ceramics and metal alloys meet all the necessary requirements. Outwardly, the endoprosthesis is similar to the human hip joint.
Its details:
- Cup endoprosthesis. This detail replaces the acetabulum of the pelvic joint. Its material is ceramics. However, there are also cups made of polymers.
- Prosthesis head. A metal part of a spherical shape with a polymer coating. This ensures smooth sliding, whenthe head rotates in the endoprosthesis cup during various limb movements.
- Prosthetic leg. It experiences the greatest loads, therefore it is always made of metal. It is a replacement for the neck and upper third of the femur.
Also, endoprostheses are divided into unipolar and bipolar. In unipolar prostheses, the patient retains his acetabulum, prosthetics only the head and neck of the femur. This is an outdated version of prostheses that were widely used before. Their use was characterized by a high incidence of destruction of the acetabulum, and they have ceased to be used in modern orthopedic practice.
Bipolar endoprostheses are called total. They perform total hip arthroplasty. All three of the above parts of the prosthesis are present here.
The service life of a hip endoprosthesis is determined by the quality of the materials used to make it. The strongest metal endoprostheses last up to 20 years. However, the combination of metal-polymer-ceramics gives the best result in terms of the combination of service life and motor activity.
Preparations
All patients who need prosthetics should undergo studies that determine the condition of the hip joint (ultrasound, MRI, radiography) to exclude all potential contraindications.
The operation does not require any special preparation. In the absence of contraindications,date of operation. On the morning of the operation, the skin around the hip joint is shaved. Eating and drinking are prohibited.
Operation process
The patient is placed on the operating table, where he is given anesthesia. The method of anesthesia is agreed upon by the anesthesiologist and the patient. The duration of the operation can reach 5 hours in difficult cases. Therefore, the best option is either spinal anesthesia or full anesthesia. The first anesthesia method does less harm, so it is better to prescribe it to older people.
After anesthesia is completed, the doctor will arrange access to the hip joint using an incision. The required incision is about 20 cm. The joint capsule is opened and the femoral head is removed, which is resected.
Bone modeling occurs in the form of an endoprosthesis. Fixation of the prosthesis occurs most often with the help of cement. Next, the articular cartilage is removed from the surface of the acetabulum with a drill, where the endoprosthesis cup is then installed.
Probable Complications
Hip replacement surgery is considered a complex surgical intervention.
It can lead to complications:
- bleeding;
- thrombosis 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
PoAccording to statistics, the majority of patients' reviews of hip arthroplasty are good. Patients are satisfied with the results of the operation. When the operation is performed 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 activities are contraindicated.
There are also unsatisfactory results after hip arthroplasty. Most often they occur in old age, if there are concomitant pathologies. In 20% of patients who underwent hip arthroplasty, patient reviews show 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 breathing exercises. The limb that has undergone a prosthesis should be kept at rest, but minimal muscle contractions should be attempted after hip arthroplasty has been performed. Rehabilitation must obey the main rule - it is necessary to consistently increase the load.
The first day after surgery
Most of the patients have to spend them in the intensive care unit. There it is best to monitor the main indicators of the body, instantly responding toall negative changes. After a few hours after the operation, a person can already spend time in a sitting position, lowering his legs down.
The operated hip joint must not be bent more than 90°. This can disrupt its design and fixation in the bone. It is best to take a sitting position under the supervision of medical staff of the clinic or relatives. They will help move the affected limb and provide first aid if dizziness occurs.
Getting out of bed
You should not get out of bed on your own for several days after the operation. Leaning on a he althy limb without using assistive devices is prohibited for several weeks. Canes or crutches can serve as assistive devices. With a satisfactory condition of the patient after an operation such as hip arthroplasty, rehabilitation allows, using assistance, to get up the very next day, however, most patients are not yet ready to do this.
Walking
The patient is allowed to walk on the 3rd day after the end of the operation. In this case, all requirements for the transition to a standing position must be met. Be sure to move the operated limb with your hands or your he althy leg until it hangs off the bed. You can get up on crutches and a he althy leg. Any attempts to lean on a sore leg are prohibited within a month after the operation, so it must be in limbo. enjoycrutches while walking is best for at least three months.
With a successful rehabilitation period, you can switch to a cane for support. You can lean on a sore leg in a month, but without transferring the entire weight of the body to it. It is necessary to start exercises after hip arthroplasty by moving the leg to the side with returning back and raising and lowering it in a standing position. Load the operated leg for two months with a load not exceeding half of the patient's body weight. You can begin to fully walk without improvised means after 4-6 months from the operation. Loads should be increased slowly and gradually.
Food
The most important component of the patient's recovery is proper nutrition. The diet should be rich in proteins, trace elements and vitamins. You should not follow a too high-calorie diet, as patients cannot actively move. Unexpended energy in this case can lead to weight gain, which will delay recovery. Muffin products, fried and fatty foods, smoked meats are not shown. Fish, lean meat, vegetables and fruits, cereals, eggs are allowed. In no case should you drink alcoholic beverages, coffee and tea.
Treatment and rehabilitation time
Treatment in the clinic lasts 2-3 weeks. This controls the wound healing process. The stitches are usually removed after 12 days. The rest of the stay in a medical institution, the patient and his relatives are trained in the simplest skills of rehabilitation of the operated leg. An x-ray is taken 3 months after the operation.hip joint. It helps to evaluate the success of the operation and the fixation of the endoprosthesis.
After the patient is discharged from the medical institution, a consultation with a rehabilitation doctor can be of great help in further rehabilitation, who will help to draw up an individual plan of rehabilitation measures. This will help make the recovery period safer and shorter. Most patients return to active life six months after surgery. Until the final rehabilitation, it is recommended to minimize the load on the limb that has undergone prosthetics. A successful hip replacement is capable of serving its owner for a long time.
Where to operate
Best of all, such operations are carried out abroad. Clinics in Israel and Germany, which specialize in performing such interventions, have gained wide popularity. However, the cost of hip arthroplasty in such clinics is very high. A reasonable alternative, if for some reason it is impossible to perform an operation abroad, is hip arthroplasty in Moscow. Russian doctors have recently made great progress in the field of arthroplasty, having performed at least 20,000 hip arthroplasty in a year. The price of this operation in our country is much less than in foreign clinics, and amounts to 38,000 rubles.
