Endoprosthetics 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, in whom the joints are affected by any disease that causes unbearable suffering and deprives a person of the ability to walk.
What is the operation
An endoprosthetics operation is performed in case of destruction of the femoral head or acetabulum. Most often, the entire hip joint changes to an artificial implant.
For the successful completion of treatment, the postoperative period is of great importance. The patient immediately after the procedure is placed in the intensive care unit under round-the-clock medical supervision.
Endoprosthetics rehabilitation can take from 4 weeks to 3-4 months, depending on the age of the patient and his general condition.
Indications for surgery
There are a number of diseases leading to the destruction of the entire joint and loss of mobility. To replace the joint lead:
- Necrosis of the femoral head.
- Coxarthrosis of the femoral head of any degree (there are 3 in total).
- Physical destruction of the joint in the area of the femoral neck as a result of trauma.
- With bilateral dysplasia, the left and right joints are replaced.
- The operation is necessary 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.
- Tumors 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 caused by the fact that a person did not have a long illness causing lameness and, as a result, impaired functioning of the muscles of the hips and back. So, immediately after the recovery operation, he can easily return to normal walking. While patients who have lost a joint as a result of a long illness, recover for a very long time.
Types of Implantations
Endoprosthetics is the replacement of a joint according to an individually selected tactic. The most common operation is a total replacement procedure. In this case, the entire joint changes 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 a single-pole operation, only the femoral head is replaced. This procedure is carried out as part of the treatment of a complex fracture of the femoral neck. The implant in this situation enters a healthy acetabulum.
With bipolar prosthetics, only the head is replaced, in this case a two-layer one. This method has recently been practically not used since it is morally outdated.
During surface surgery, the joint remains in place, but a special cap is installed on it, and a place for it in the acetabulum fossa. This type of intervention cannot protect the joint for a long time - 3-5 years, but no more. This is caused by the fact that after such a procedure, soft tissue inflammation often occurs at the site of intervention.
Preparation for surgery
Joint replacement surgery is a rather complicated surgical procedure, which is why it is performed under general anesthesia and only after the patient’s preliminary preparation. Such procedures are urgently performed to treat a complex fracture of the femoral neck. Endoprosthetics of the knee joint after an injury can also be urgently performed. Usually this is done for athletes who want to return to competitions faster.
In all other cases, before the operation, the patient undergoes a full medical examination, during which blood is taken from him for analysis of coagulability and the presence of infectious diseases. All endoprosthetics centers are required to check the patient for AIDS, syphilis and hepatitis. It also checks the condition of the person’s heart and blood pressure. These indications will be necessary for immersion in anesthesia. An experienced anesthetist must carry out specific studies and calculate individual doses of sleeping pills and painkillers for each individual patient.
Contraindications for surgery
Unconditional contraindications to surgery for the replacement of the hip joint 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 of cardiovascular diseases, lungs and bronchi.
Also, the operation is not done if a person has a mental illness, drug addiction or alcoholism.
The implant is not installed by a bed patient. Firstly, they are physically unable to undergo rehabilitation. In addition, the installation of the implant to a paralyzed person is impractical.
At the discretion of the attending physician, the patient has the presence of renal or liver failure, peptic ulcer of the stomach and duodenum, excess weight. In these cases, surgery 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 liver disease or other internal organ, for example, an open stomach ulcer.
Procedure
Endoprosthetics is a certain sequence of actions that cannot be violated in any case:
- First of all, the surgical field is carefully treated with an antiseptic. Harnesses are established to limit bleeding in the large vessels of the limb.
- The next stage is the opening of access to the joint through soft tissues. The surgeon tries to minimize damage to large vessels and muscles.
- The articular capsule is then removed.
- After that, the femoral head and acetabulum are filed.
- A cup of the prosthesis is placed in the pelvic bones; it must fit exactly in size.
- An implant leg is placed in the femur. For this, a hole for it is pre-drilled in it. The sphere of an artificial joint is attached to the leg.
- A spherical prosthesis on the femur is inserted into an artificial cup, the joint is checked for performance.
- The surgical field is cleaned 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 stitch after surgery - up to 8 centimeters, which looks more aesthetically pleasing than the usual scar 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 made of
Modern prostheses are 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-metal combination, where both the hinge and the cavity are made of titanium.
Medium price implant is a combination of ceramic and polyethylene. The friction coefficient in this case is much lower and accordingly 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 qualification of the surgeon, the cleanliness of the operation and the postoperative rehabilitation period.
Postoperative complications
In general, reviews about endoprosthetics are positive, but there is a risk of a number of complications in the postoperative period. First of all, it is infection of a wound with an infection. Secondly, it is a severe pain in the thigh. Thirdly, a rather high risk of pulmonary embolism. When installing a poor-quality product or its improper operation, dislocations, subluxations of the joint or damage to the device itself are possible. That is why the rehabilitation of joint replacement is carried out under the supervision of a doctor. He teaches the patient to walk and load the leg correctly.
Terms of Use
Endoprosthetics 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:
- Do not bend low or squat.
- At first you need to walk on crutches and with a cane. Moreover, exactly the period indicated by the doctor, even if the pain has passed 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 maintain muscle tone, it is necessary to regularly do the physiotherapy exercises prescribed by the physiotherapist.
- The field of full recovery must be examined by a specialist 2 times a year.
Federal centers
Endoprosthetics centers:
- FSBI Russian Research Institute of Traumatology and Orthopedics R. R. Wreden. " Address: St. Petersburg, st. Academician Baykov, d. 8.
- FSBI “NMHTs im. N. I. Pirogov. " Address: Moscow, st. Lower Pervomayskaya, d. 70.
- Federal State Institution “Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya. L. Tsivyan. " Address: Novosibirsk, st. Frunze 17.
- FSBI “FC of traumatology, orthopedics and endoprosthetics”. Address: Cheboksary, st. Fedor Gladkov, d.33.
- Federal State Institution "Nizhny Novgorod Research Institute of Traumatology and Orthopedics of the Federal Agency for VMP". Address: Nizhny Novgorod, Verkhnevolzhskaya embankment, d.18.
We must not forget that the endoprosthesis, with all its manufacturability and strength, is still an artificial joint. It will never replace a full-fledged healthy joint, and you need to treat it carefully and carefully.