Arthroplasty is a surgical operation to replace a person's own joint with an artificial one. In fact, this is the last chance to return to normal life for 250 thousand patients a year throughout Russia. Basically, these are people of middle and old age, whose joints are affected by some kind of disease that causes unbearable suffering and deprives a person of the ability to walk.
What is the operation
Arthroplasty is performed in case of destruction of the femoral head or acetabular recess. Most often, the entire hip joint is replaced with an artificial implant.
The postoperative period is of great importance for the successful completion of treatment. The patient immediately after the procedure is placed in the intensive care unit under round-the-clock medical supervision.
Rehabilitation of arthroplasty can take from 4 weeks to 3-4 months, depending on the age of the patient and his general condition.
Indications foroperations
There are a number of diseases that lead to the destruction of the entire joint and loss of mobility. Lead to joint replacement:
- Necrosis of the femoral head.
- Coxarthrosis of the femoral head of any degree (there are 3 in total).
- Physical destruction of a joint in the region of the femoral neck as a result of an injury.
- For bilateral dysplasia, the left and right joints are replaced.
- Surgery needed for ankylosing spondylitis.
- Degenerative-dystrophic diseases of the joints, such as rheumatism, psoriasis, gout. With these pathologies, the connective tissue covering the joint is completely destroyed.
- Tumours in the femoral neck and acetabulum.
The most positive prognosis after implantation of an artificial joint is given with a severe fracture of the femoral neck. This is due to the fact that the person did not have a long-term illness that causes lameness and, as a result, disruption of the muscles of the hips and back. So, immediately after the reconstructive surgery, he can easily return to normal walking. Whereas patients who have lost a joint as a result of a long illness recover for a very long time.
Types of implantation
Arthroplasty is a joint replacement according to an individually chosen tactic. The most common operation is the total replacement procedure. In this case, the entire joint is changed along with the femoral head and acetabulum. The implant is able to serve its owner up to 30 years,being the most durable way to return mobility to a person.
In unipolar surgery, only the femoral head is replaced. This procedure is performed as part of the treatment of a complex fracture of the femoral neck. The implant in this situation enters a he althy acetabulum.
In bipolar prosthetics, only the head is also replaced, in this case a two-layer one. This method is practically not used recently as it is obsolete.
In superficial surgery, the joint remains in place, but a special cap is placed on it, and there is a place for it in the acetabulum. This type of intervention cannot protect the joint for a long time - 3-5 years, but no more. This is due to the fact that after such a procedure, inflammation of the soft tissues often occurs at the site of intervention.
Preparation for surgery
Arthroplasty surgery is a rather complicated surgical procedure, which is why it is performed under anesthesia and only after preliminary preparation of the patient. Urgently such procedures are performed to treat a complex fracture of the femoral neck. It is also possible to urgently perform knee arthroplasty after an injury. This is usually done for athletes who want to get back to competition as soon as possible.
In all other cases, before the operation, the patient undergoes a complete medical examination, during which blood is taken from him for analysis of coagulation and the presence of infectious diseases. All endoprosthesis centers are required to test the patient for AIDS,syphilis and hepatitis. The condition of the person's heart and his blood pressure are also checked. These indications will be necessary for immersion in anesthesia. An experienced anesthetist necessarily conducts specific studies and calculates individual doses of sleeping pills and painkillers for each individual patient.
Contraindications for surgery
Unconditional contraindications to hip replacement surgery include the presence of inflammation in the patient's body. It can be a disease of any organ, just caries or even furunculosis on the skin.
The patient should not have problems with the heart, blood vessels and respiratory system. Otherwise, the patient must first undergo treatment for cardiovascular diseases, lungs and bronchi.
Also, the operation is not performed if a person has a mental illness, drug addiction or alcoholism.
The implant is not placed in bedridden patients. Firstly, they will not be physically able to undergo rehabilitation. In addition, the installation of an implant in a paralyzed person is impractical.
At the discretion of the attending physician, the presence of a patient with renal or hepatic insufficiency, peptic ulcer of the stomach and duodenum, excess weight is left. In these cases, the operation is prescribed based on the severity of concomitant diseases and the general condition of the patient.
There are cases when a person, after a successful operation, died due to an exacerbation of a disease of the liver or another internal organ, for example, an open stomach ulcer.
Procedure progress
Arthroplasty is a certain sequence of actions that must not be violated in any case:
- First of all, the surgical field is carefully treated with an antiseptic. Tourniquets are installed to limit bleeding through the large vessels of the limb.
- The next step is to open access to the joint through soft tissues. The surgeon tries to minimize damage to large vessels and muscles.
- Then the joint capsule is removed.
- After that, the femoral head and acetabulum are filed.
- The cup of the prosthesis is placed in the pelvic bones, it must fit exactly in size.
- The leg of the implant is placed in the femur. To do this, a hole for it is pre-drilled in it. An artificial joint sphere is attached to the leg.
- Ball-shaped prosthesis on the femur is inserted into the artificial cup, the articulation is tested for performance.
- The operating field is cleared of blood and sutured. The leg is fixed with an elastic bandage.
In some cases, doctors try to minimize the incision to install an artificial joint. This allows you to leave a small seam after the operation - up to 8 centimeters, which looks more aesthetically pleasing than the usual scar that is long from the middle of the thigh to the waist. But a small incision complicates the installation of the structure, so it is rarely done. Usually the incision opens the joint well, its length is 25–30 cm.
What is it made of
Modern denturesare made of various materials, the main task of which is to minimize friction between the cup and the hinge. The cheapest and most affordable is the metal-to-metal combination, where both the hinge and the cavity are made of titanium.
The medium price implant is a combination of ceramic and polyethylene. The coefficient of friction in this case is much lower and therefore the durability is higher.
The most expensive and durable is a ceramic product. Whatever the prosthesis is made of, its durability is influenced not only by the material, but also by the correct installation, the qualifications of the surgeon, the cleanliness of the operation and the postoperative period of rehabilitation.
Postoperative complications
In general, reviews of arthroplasty are positive, but there is a risk of a number of complications in the postoperative period. First of all, it is an infection of the wound with an infection. Secondly, it is the strongest pain in the thigh. Thirdly, there is a rather high risk of pulmonary embolism. When installing a low-quality product or its improper operation, dislocations, subluxations of the joint or breakage of the device itself are possible. That is why the rehabilitation of joint arthroplasty is carried out under the supervision of a physician. He teaches the patient to walk correctly and load the leg.
Operating Rules
Arthroplasty is not a panacea. In order for the device to serve a person until the end of his life without breakdowns and damage, a number of requirements must be observed:
- Nolean or crouch low.
- At first, you need to walk on crutches and with a cane. Moreover, exactly the period indicated by the doctor, even if the pain is gone and the leg is working normally.
- In order to prevent blood clots, you need to take a course of taking anticoagulants prescribed by your doctor.
- After discharge from the hospital, the patient should be regularly examined by the attending physician.
- To keep the muscles in good shape, it is necessary to regularly do the therapeutic exercises prescribed by the physiotherapist.
- The field of complete recovery must be examined by a specialist 2 times a year.
Federal centers
Arthroplasty Centers:
- FGBU Russian Research Institute of Traumatology and Orthopedics named after A. I. R. R. Vreden. Address: St. Petersburg, st. Academician Baykova, 8.
- FGBU "Nmkhts im. N. I. Pirogov. Address: Moscow, st. Lower Pervomaiskaya, 70.
- Novosibirsk Research Institute of Traumatology and Orthopedics named after N. N. Ya. L. Tsivyan. Address: Novosibirsk, st. Frunze 17.
- FGBU “FC of Traumatology, Orthopedics and Endoprosthetics”. Address: Cheboksary, st. Fedora Gladkova, 33.
- FGU "Nizhny Novgorod Research Institute of Traumatology and Orthopedics of the Federal Agency for VMP". Address: Nizhny Novgorod, Verkhnevolzhskaya embankment, 18.
We must not forget that the endoprosthesis, for all its manufacturability and strength, is still an artificial articulation. It will never replace a full-fledged he althy joint, and you need to treat it carefully and carefully.
