Joints that are sore and lack mobility are a hindrance in the performance of everyday actions, make it impossible to lead a normal life. Especially difficult if the hip joint is affected. Joint endoprosthetics help restore lost function of the limb, being often the only way for the patient. Indications for this operation are more than 300 thousand people a year.
The first and main sign of joint disease is pain. At first, the pains are of low intensity, but in the future, with the progression of the disease, the pain intensifies, 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 immobility. Such patients conservative treatment is no longer able to help save the affected hip joint.
Hip arthroplasty is currently one of the most modern methods of surgical care for lesions of this joint. During this operation, the affected tissues that make up the hip joint change to artificially created prostheses.
The structure and function of the hip joints
The hip joint is one of the largest bone joints in the human body. The loads experienced by him during the life of a person are very large, since it serves to connect the lower limb and the pelvis.
The 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 femoral head is fixed;
- joint cartilage - a tissue having a gel-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 alleviate friction of articular surfaces;
- joint capsule and ligamentous apparatus - connective tissue, which serves to maintain joint surfaces and ensure joint stability.
Muscles with tendons, fastened in the area 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 manages the provision of walking and support functions.
Why is arthroplasty needed?
For the doctor to raise the question of replacing his hip joint with a prosthesis before the patient, weighty reasons are needed. The operation is prescribed if the defeat of the components of the joint has reached such an extent that a 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, endoprosthetics can be a way out.
Among the ailments that can cause damage to the joint, requiring surgery, can be called:
- deforming bilateral osteoarthrosis in the case of severity 2 and 3;
- deforming osteoarthrosis of the 3rd degree with the deformation of one of the joints;
- hip ankylosis that occurs with rheumatoid arthritis and due to ankylosing spondylitis;
- aseptic necrosis of the femoral head as a result of injuries and with impaired blood circulation;
- head and neck injuries in the form of a fracture in the elderly;
- tumors in the ankle area requiring surgical treatment.
Replacement of the hip joint is advisable only in the case of complete loss of the possibility of motor activity and walking. The final decision on the operation is made taking into account all factors.
Contraindications for surgery
There are frequent cases where even people experiencing an urgent need for hip joint arthroplasty cannot go for surgery because of contraindications.
The most common restrictions include:
- situations when the patient will not be able to independently move, even if the operation is performed;
- chronic disease in the decompensation stage (heart failure, cerebrovascular accident, liver failure), when the operation can aggravate existing problems;
- chronic lung damage, causing respiratory and ventilation failure (emphysema, asthma);
- various inflammations of bones, skin or soft tissues in the area of the hip joint;
- osteoporosis, leading to insufficient bone strength and the risk of breaking the bone after surgery during normal walking;
- pathologies in which the bone marrow canal is absent in the femur.
Endoprosthesis Classification
The endoprosthesis replacing the affected hip joint must have sufficient strength, it must be firmly fixed and have an inertness to the tissues of the patient's body. Modern endoprostheses made from polymers, ceramics and metal alloys meet all the necessary requirements. Externally, the endoprosthesis is similar to the human hip joint.
Its details:
- Endoprosthesis Cup. This part replaces the acetabulum of the pelvic joint. The material of its manufacture is ceramics. However, there are also cups made of polymers.
- The head of the prosthesis. Spherical metal part with polymer coating. This ensures the softness of the slip when the head rotates in the cup of the endoprosthesis when performing various movements of the limb.
- The leg of the prosthesis. It experiences the greatest load, so it is always made of metal. It is a replacement for the neck and upper third of the femur.
Endoprostheses are also divided into unipolar and bipolar. In unipolar prostheses, the patient retains his acetabulum, prosthetizing only the head and neck of the thigh. This is an outdated version of prostheses that have been widely used before. Their use was characterized by a 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. Here 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 for its manufacture. The strongest metal endoprostheses last up to 20 years. However, the combination of metal-polymer-ceramic gives the optimum result in combining the service life and motor activity.
Preparatory Activities
All patients who need prosthetics should be tested to 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, the date of the operation is assigned. On the morning of the day of surgery, the skin in the area of the hip joint is shaved. Food and drink are prohibited.
Operation process
The patient is placed on the operating table, where he is anesthetized. The method of anesthesia is agreed upon by the anesthetist and the patient. The duration of surgery can reach 5 hours in difficult cases. Therefore, the best option is either spinal anesthesia, or full anesthesia. The first method of anesthesia does less harm, so it is better to prescribe it to older people.
Upon completion of the anesthesia, the doctor, using the incision, organizes access to the hip joint. The required incision is about 20 cm. The capsule of the joint is opened and the head of the femur is removed, which undergoes resection.
Bone modeling takes place in the form of an endoprosthesis. Fixation of the prosthesis occurs most often with the help of cement. Further, articular cartilage is removed from the surface of the acetabulum with a drill, where the endoprosthesis cup is then installed.
Probable complications
Hip arthroplasty is considered a complex surgical procedure.
It can lead to complications:
- bleeding;
- thrombosis in the veins of the lower extremities;
- suppuration of the endoprosthesis and postoperative wound;
- hematoma;
- endoprosthesis rejection;
- complications of the cardiovascular system.
Careful preparation of the operation minimizes the risk of complications.
Operation Summary
According to statistics, the reviews of patients on the hip joint are mostly good. Patients are satisfied with the results of the operation. When performing surgery in people of a relatively young age without concomitant diseases, the function of the hip joint is fully restored. A person can walk and even engage in physical education without overloading the prosthesis. Sports activities are contraindicated.
There are also unsatisfactory results after hip replacement surgery. Most often, they happen in old age, if there are concomitant pathologies. In 20% of patients undergoing hip replacement, patient reviews show disappointment with the results of the operation.
Postoperative Recovery
Rehabilitation of patients should start immediately after surgery. These are exercises after hip replacement, and breathing exercises. The limb that underwent prosthetics should be kept at rest, but it is necessary to try to perform minimal muscle contractions after hip joint arthroplasty has been performed. Rehabilitation must obey the main rule - it is necessary to consistently increase the load.
The first day after surgery
Most patients have to spend them in the intensive care unit. There it is best to monitor the main indicators of the body, instantly reacting to all negative changes. After several hours after the operation, a person can already spend time in a sitting position, lowering his lower legs.
The operated hip joint must not be bent more than 90 °. This can disrupt its construction and fixation in the bone. It is best to take a sitting position under the supervision of the clinic's medical staff or relatives. They will help in moving the diseased limb and will provide first aid if dizziness occurs.
Getting out of bed
You should not get out of bed for several days after surgery. Relying on a healthy limb without using assistive devices is prohibited for several weeks. Aids can be canes or crutches. If the patient is in satisfactory condition after an operation such as hip joint replacement, rehabilitation allows using the help 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 observed. Be sure to move the operated limb with your hands or healthy leg until hanging from the bed. You can get up resting on crutches and a healthy leg. Any attempts to lean on a sore leg are prohibited for a month after the operation, so it should be in a suspended state. It is best to use crutches while walking for at least three months.
With a successful course of the rehabilitation period, you can go to a cane for support. You can rely on a sore leg in a month, but without transferring the whole weight of the body to it. You need to start the exercises after hip joint arthroplasty by taking the leg to the side with the return back and raising and lowering it in a standing position. Load the operated leg for two months with a load not exceeding half the patient’s body weight. You can start 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 the patient’s recovery is proper nutrition. In the diet should be a lot of proteins, trace elements and vitamins. Do not stick to too high-calorie diets, as patients cannot actively move. Unspent energy in this case can lead to weight gain, which will delay recovery. Muffin products, fried and fatty products, smoked products are not shown. Allowed fish, lean meat, vegetables and fruits, cereals, eggs. In no case should you drink alcohol, coffee and tea.
Treatment and rehabilitation time
Treatment in the clinic lasts 2-3 weeks. At the same time, the healing process is controlled. Typically, sutures are removed after 12 days. The rest of the time spent in the medical facility, the patient and his relatives learn the simplest skills of rehabilitation of the operated leg. 3 months after surgery, a X-ray of the hip joint is performed. It helps to evaluate the success of the operation and the fixation of the endoprosthesis.
After the patient is discharged from the medical institution, consultation with a rehabilitation doctor can help a lot in further rehabilitation, which will help to draw up an individual plan of rehabilitation measures. This will help make the recovery period safer and shorter. In most patients, a return to active life occurs six months after surgery. Before the final rehabilitation, it is recommended to minimize the loads of the limb that underwent prosthetics. The hip joint, the endoprosthetics of which was successful, is able to serve its master for a long time.
Where to operate
Such operations are best carried out abroad. The clinics of Israel and Germany, which specialize in performing such interventions, gained wide popularity. However, the cost of hip replacement 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. Recently, Russian doctors have made great progress in the field of endoprosthetics, having done hip arthroplasty for at least 20 thousand times a year. The price of this operation in our country is much lower than in foreign clinics, and amounts to 38,000 rubles.