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Over the past 10 years in trauma department Regional Clinical Hospital of Rostov-on-Don for degenerative-dystrophic lesions of the hip joints, fractures and false joints of the femoral neck, injuries acetabulum, tumor processes in 356 cases they were usedtotal endoprostheses hip joint
produced by MATHYS, Switzerland.
Why do we use prosthetics from this company? We can list the following points that made us dwell on them. The quality of these hip joint implants is significantly higher than domestic ones, a wide range of cement-free and cemented models, prostheses for revision arthroplasty, the originality of the cup and excellent options for legs. Good, easy-to-use, high-quality instruments allow the operating traumatologist to successfully perform operations.
Of the 356 patients, there were 144 men and 212 women. The age of the patients varied: from 22 to 83 years, but largest group Those operated on included persons from 40 to 60 years old - 215 people (61%). By pathological processes hip joints, patients were distributed as follows: degenerative-dystrophic lesions of the hip joint of various etiologies - 202; femoral neck fractures and nonunion - 63; hip dysplasia - 44; rheumatic lesions - 35; tumors - 12. In most patients, external transgluteal access according to Harding was used. If possible, preference was given to spinal and epidural anesthesia, and this type of anesthesia was used in 164 cases, endotracheal anesthesia in 192. Intraoperative blood loss ranged from 150.0 to 300 ml in primary endoprosthetics, up to 1500 ml in revision endoprosthetics. In the near future postoperative period blood loss through drainages up to 500 ml was noted in 225 (63.2%), from 500 to 900 ml - in 90 (36.8%). During surgery and in the postoperative period, donor plasma and red blood cells were used, but in 36 cases autologous blood was used.
In our observations, cementless endoprostheses were used 220 times, cement ones - 163. Cement was used by different manufacturers.
For cementless arthroplasty, an RM cup with titanium coating, SHS (Spotorno type) and SVN (Zweimuller type) stems were used. For cemented arthroplasty, a standard and lateral SSA (Muller type) stem and a SSA low-profile cup were used. Müller's strengthening CSE component was used in 52 patients with severe acetabular dysplasia, post-traumatic deformities, protrusive coxarthrosis, and severe osteoporosis in elderly patients. The Wagner stem and revision RM cup were used for revision arthroplasty in 10 cases. 26 patients underwent surgery on 2 hip joints. The operation to replace the affected bilateral joint was performed no earlier than 3 months from the date of the first total endoprosthetics. Not a single operated patient died in the department. We encountered such serious complications as deep tissue suppuration that required removal of the prosthesis in 2 patients who had a history of purulent processes in the operated hip joint. There were 4 cases of dislocations in the artificial hip joint. In 3 patients, reductions were successfully performed closed under an image intensifier, and in only one patient - open way. In one patient, an error was made when installing the prosthesis into the thigh - the leg of the prosthesis perforated back wall hip, which subsequently required re-endoprosthetics of the femoral component.
Long-term results from 1 year to 10 years were monitored in 212 patients. The results were assessed using the Harris scale. There was no audit. Good results - in 198 (93.3%) patients, satisfactory - in 12 (5.6%), unsatisfactory - in 2 (0.9%).
Over 20 years, more than 1,200 patients have been operated on in the trauma department of the Regional Clinical Clinical Hospital. Endoprostheses from Sivash, Virabov, Gerchev, Orthotech, Phoenix, and ESI were used. Our experience in managing such patients and the results of operations on hip replacement with Mathys prostheses allows us to believe that these prostheses meet the requirements for them of both orthopedic traumatologists and operated patients.
Zerkin G.D., Ivanov V.I., Antonets I.P., Basov S.V., Chernogorov P.V., Fedotov I.G., Elfimov A.L., Prokhorsky D.A., Ivanov D.V. ., Zinovchenkov V.A.
State Healthcare Institution "Rostov Regional Clinical Hospital"
Joint endoprosthetics is currently one of the most common types of operations that make it possible to replace some components of the joint with prostheses that have the shape necessary for normal functioning joint Endoprostheses allow many people to return to a normal lifestyle.
In order for implants to take root in the patient’s body and at the same time have increased strength, special materials are used in their manufacture. That is why the cost of an endoprosthesis knee joint or hip implant is quite high. To produce implants of this type, certain metals, ceramics, plastics that are durable and other high-tech materials are used.
A modern implant for the shoulder, knee or hip joint endoprosthesis, the price of which depends on what materials were used for its production, is an innovative design, for the development and production of which the latest developments from various fields of science and technology are used.
Modern implants that act as joint components can operate inside the human body for approximately fifteen to twenty years; some endoprostheses have a service life of up to thirty years. After the implant wears out, be it a hip, knee, shoulder or any other endoprosthesis, it is replaced with a new one surgically. Modern medicine uses implants that can replace components not only large joints, but also small ones, for example, the joints of the fingers.
Recently, mesh endoprostheses have been in great demand, which have found wide application in the field of restoration of the chest and abdominal walls. A mesh endoprosthesis will also help in removing a hernia - in hernioplasty. The use of this type of implant helps eliminate the hernia without major surgical intervention. Mesh endoprosthesis, which can be purchased from specialized companies (including ours), is also indispensable in the treatment of many other diseases and defects.
Biological compatibility with the patient, good resistance to infections and increased mechanical strength are the main qualities that a modern mesh endoprosthesis should have. The price of such implants is high, since expensive synthetic materials are used in their production. To improve biocompatibility and other qualities of the endoprosthesis, the mesh is sometimes covered with a special polymer film, which not only reduces the chance of rejection, but also stimulates the growth of connective tissue, and also helps to form a uniform scar that forms after implantation of the endomesh.
Here you can find a wide selection of endoprostheses of various types for a variety of needs. There is a large assortment of implants from the DePuy brand, the production of which is carried out by the group of companies of the same name, part of the Johnson & Johnson corporation. The De Pew endoprosthesis is a modern high-quality implant, the cost of which is relatively low, and the quality is at an international level.
Straight cement Muller stem
The M. Muller endoprosthesis is the most popular cement endoprosthesis in the world, with a record number of implantations. According to the Swedish Register in 2001, the Müller endoprosthesis manufactured by Sulzer was recognized as the best cement endoprosthesis in the world. The original Müller endoprosthesis in various modifications is used in clinical practice for more than 25 years. In 2003 More than 1 million Müller endoprostheses manufactured by Sulzer have been implanted worldwide. Unfortunately, there is a market a large number of unauthorized copies and counterfeits of this endoprosthesis. According to numerous publications by doctors from clinics around the world, the survival rate of the original endoprosthesis over 15 years of operation is 98%.
This indicator provided the Müller endoprosthesis with the “gold standard” category in endoprosthetics, and Professor Müller World Congress in traumatology and orthopedics was awarded the honorary title of “orthopedist of the century.” The leg of the endoprosthesis is a cobalt-chromium or steel implant, which implements Professor Müller’s idea of self-centering and self-fixation of the prosthesis in the medullary canal. The cemented self-locking stem has better rotational stability due to shallow longitudinal grooves and a rough proximal surface. The flat double wedge profile ensures reliable fixation with correct positioning of the stem (no varus or valgus deviation).
This leg has 8 standard sizes; the head fits onto a standard Eurocone 12/14 mm. The neck-shaft angle is 135. To increase the length of the neck, a lateralized version of the stem is used. There are 8 implant sizes.
Indications for use:
- All types of coxarthrosis in the absence of pronounced dysplastic deformation of the proximal part femur. If the femoral neck is longer, it is advisable to use a lateralized endoprosthesis stem.
- Dysplastic deformity of the proximal femur
Endoprosthesis M. Müller CDH (Monoblock) Author M. Müller Material: Protasul S-30
The CDH endoprosthesis is specially designed for implantation in patients with a small acetabular cavity with severe development of hip dysplasia, as well as in patients with a narrow medullary canal of the femur. The diameter of the endoprosthesis head is 22 mm, which allows the use of more durable polyethylene liners. Fixation of the endoprosthesis is carried out according to the principle of self-locking of the leg in the medullary canal.
The endoprosthesis has 5 sizes
Indications:
- All types of coxarthrosis in the absence of severe dysplastic deformation of the proximal femur
- Rheumatoid arthritis
- Narrow medullary canal
Contraindications:
- Cylindrical shape of the proximal part of the femoral medullary canal
Cementless modular system "METABLOC" Material: Protasul - S30,-100
The Metablock system is a unique system that combines the main characteristics of well-known endoprostheses in the world. Three-dimensional conical shape and anti-rotation ribs ensure centering and self-fixation of the endoprosthesis. The system has proven high level effectiveness, the results of controlled, long-term clinical observations showed a 97% survival rate over 20 years.
The Metablock system is available in two versions, for both cemented and cementless fixation, thus covering a maximum range of indications.
The set of instruments for implantation of cementless and cemented systems is the same, which allows the surgeon to intraoperatively change the previously planned type of fixation of the femoral component. Fixation of the Metablock endoprosthesis is carried out mainly in the metaphysis, thanks to its three-dimensional conical shape. This ensures physiological load transfer for both options for fixing the endoprosthesis. The installation technique makes it possible to leave a gap of about 0.7 mm between the endoprosthesis stem and the cortical bone, in the distal section, to minimize distal fixation, and for the cement stem - the possibility of forming a solid, circular cement mantle.
There are 11 standard sizes of cementless version and 5 of cement version. The head fits onto a standard Eurocone 12/14 mm. The neck-shaft angle is 140.
Indications for installation of a cementless Metablok stem:
- Patients age up to 60 years
- No signs of osteoporosis (Singh index not lower than 5)
Contraindications for installing a cementless Metablok stem:
- Patient age over 60 years
- Rheumatoid arthritis
Indications for installing the Metablock cement foot:
- All types of coxarthrosis in the absence of significantly pronounced dysplastic deformation of the proximal femur.
Contraindications for installing the Metablock cement foot:
- Cylindrical shape of the proximal part of the femoral medullary canal
- Femoral neck anteversion angle 30 or more
- Significantly expressed dysplastic deformity of the proximal femur
- This leg has 6 standard sizes; the head fits onto a standard Eurocone 12/14 mm. The neck-shaft angle is 140
CLS cementless total hip replacement system. L. SPOTORNO Material: Protasul-100
This leg has 13 standard sizes, the head fits on a standard Eurocone 12/14 mm. The neck-shaft angle is 145.
Indications for use:
- Patients age up to 60 years
- No signs of osteoporosis in patients (Singh index not lower than 5)
- Flute-shaped femur
- The value of the cortico-morphological index is not lower than 2.7
Contraindications for use:
- Patient age over 60 years
- Moderate and severe osteoporosis in patients (Singh index below 5)
- Dysplastic deformity of the femur
- The value of the cortico-morphological index is below 2.7
- Rheumatoid arthritis
Cementless conical Wagner endoprosthesis Material: Protasul-100 Author H. Wagner
The endoprosthesis stem is a three-plane press-fit, which is the dominant concept for cementless endoprostheses in Europe. The 3D press-fit system provides reliable cementless fixation for flute-shaped and cylindrical medullary canal shapes. The system has the highest survival rate for cementless endoprostheses in the world. Optimal fit of the prosthesis is achieved by wedging the stem into the medullary canal. The anterior and posterior surfaces of the stem have parallel conical ribs that provide rotational stability to the stem. A special production technology makes it possible to achieve micro-irregularities in the surface of the endoprosthesis of 3-5 µm, corresponding to the size of the bone trabeculae, which ensures the most reliable secondary fixation due to osseointegration.
Excellent primary stability, physiological load transfer and high biocompatibility of the material with a textured surface ensure rapid and long-lasting osseointegration and good secondary stability. High rotational stability of the endoprosthesis is achieved due to the rectangular cross-section of the leg, and the special shape of the endoprosthesis ensures uniform load transfer and maximum preservation of bone tissue.
Indications for use
- Flute-shaped proximal femoral canal
- Patients age up to 60 years
- Singh index not lower than 5
- The value of the cortico-morphological index is not lower than 2.7
Contraindications for use:
- Cylindrical shape of the proximal femoral canal
- Patient age over 60 years
- Moderate and severe osteoporosis in patients (Singh index below 5)
- Dysplastic deformity of the femur
- The value of the cortico-morphological index is below 2.7
The neck-diaphyseal angle of the endoprosthesis is 131 degrees. There are 12 standard sizes and a revision version of the endoprosthesis.
Wagner Conical Endoprosthesis
Design Features
- Standard stem (135°) and New offset (125°)
- As the offset increases, the area of contact with the bone increases
- Thinner neck for standard and offset versions
- New proximal fixation design (shoulder and ribs)
28mm Polyethylene Low Profile Cup
This component is a low profile cement cup with an internal diameter of 28mm. The cup is made from ultra-high molecular weight polyethylene (Sulen), which has improved characteristics compared to the traditionally used chirulen. The cup has 12 standard sizes (from 42 to 64 mm), the cup is installed on cement in the acetabulum, or in the Müller reinforcing ring or the Bursch-Schneider reinforcing cup of the appropriate or bigger size in case of severe osteoporosis or significant destruction of the acetabulum.
Material: Protasul-Ti
The standard cup is a modular acetabular component of the endoprosthesis, consisting of a titanium body and a polyethylene liner. The cup can be installed in combination with all SULZER endoprosthetic stems. Cementless fixation of the body in the acetabulum is achieved due to the effect of a tight “press fit” fit and subsequent osseointegration. Additional fixation with screws is possible in cases where the condition of the acetabulum requires it.
Primary fixation is achieved by fixing the titanium cup body in the acetabulum, treated with a smaller cutter, and by the spikes located on the surface of the body, which ensure stability of the implant position, including rotation. Secondary osseointegration occurs due to the rough surface of the cup and spines.
There are 10 cup sizes.
Indications for use:
Contraindications for use:
- Unsatisfactory condition of the bone tissue in the acetabulum area
- Various anatomical disorders in the acetabulum.
Expanding cup SPOTORNO CLS. Author L. SpotornoMaterial: Protasul-100
The cup consists of a body and a polyethylene liner. The insert has a thread and is screwed into the body. The basic shape of the cup is a slightly enlarged hemisphere, the body is star-shaped, consists of 6 lobes, evenly increasing towards the “equator”. The protruding teeth are arranged radially at different levels. The cup is inserted into the acetabulum using compression forceps, and with the help of a special screw-in expansion cone, it opens completely.
The teeth, embedded in the bone, provide primary fixation and stability of the cup. Uniform distribution of implant pressure on the bone in the equatorial region due to the expanding mechanism and press-fit effect allows for maximum osseointegration.
There are 9 cup sizes.
Indications for use:
- Anatomically correctly formed acetabulum in patients with various types of coxarthrosis.
Contraindications for use:
- Hip dysplasia
- Osteoporosis
- Presence of anatomical defects of the acetabulum
- Rheumatoid arthritis
Acetabular reinforcing Müller ring Material: Protasul-Ti
This component is the world famous original cementless reinforcement ring of Professor M. Müller. At a reasonable price, the ring has wide range indications for use. The ring is installed using the press-fit method with additional fixation with 3-5 cancellous screws, which ensures high primary stability in the load zone.
The ring is made of blasted pure titanium using a unique isothermal forging method, which ensures its exceptional strength properties. The rough surface of the ring promotes the process of rapid osseointegration, because the size of microroughnesses on the surface of the implant corresponds to the size of the bone trabeculae. The hole in the bottom of the ring allows you to control the contact with bone tissue. The independent position of the polyethylene liner allows for optimal cup orientation, and the presence sufficient quantity holes allows screws to be inserted in the most anatomically justified directions. A fairly large number of implant sizes are available. Installation of the ring does not require special tools.
Indications for use:
- Primary endoprosthesis replacement with insufficient bone tissue reserve
- Revision endoprosthetics for acetabular defects
- Phenomena of osteoporosis
- Acetabular roof cysts
- Acetabular dysplasia or small acetabular size
- Rheumatoid arthritis
Contraindications for use:
- Significant bone defects of the acetabulum, which do not allow fixation of the ring with the proper degree of stability
- Protrusion of the acetabulum
- The ring has 12 sizes (from 36 to 58 mm)
Spongy screw
Cancellous screws are available in two types - for reinforcing rings and for cementless Wagner cups. The screws have high strength qualities, are made of titanium, head diameter is 6.5 mm, length from 15 to 70 mm.
Burch-Schneider antiprotrusion cupBurch/Schneider Material - Protasul-Ti
The Bursch-Schneider antiprotrusion cup is an adequate, reliable stabilizing implant that has been used with convincing results for over 25 years. Today this product is effective means, used for numerous anatomical and pathological situations with poor bone quality, especially with frequent revisions.
High degree protrusion of the floor of the acetabulum, as well as the increasing number of revision endoprosthetic operations, necessitated its creation. In some cases, implantation of this component is the only solution to the problem of protrusion. The cup has a certain coefficient and modulus of elasticity, which allows you to most accurately simulate the physiological distribution of load in the pelvic area.
Indications for use:
- Protrusion of the floor of the acetabulum; Revision hip arthroplasty in cases with large defects bottom or roof of the acetabular cavity
Tribological couple METASUL.
A unique tribological pair of metal-to-metal type (head-liner) with wear no more than 1.5-2 microns/year.
The Metasul head is available with a diameter of 28mm (S,M,L) and has a 12\14 cone. An eccentric head option is available to correct the 7.5° neck angle in any direction. and vice versa. Metasul inserts are available for all types of cups and reinforcing rings.
Important! It is allowed to install the Metasul head only with the Metasul acetabular component.
Often it is the only method of restoring motor activity. Installation of the implant eliminates the pain syndrome that does not leave the patient with diseases of the musculoskeletal system.
Modern types of prostheses are designed to completely imitate the original joint and fulfill its functional capabilities.
A hip joint implant with a metal friction pair is used less and less in practice due to metal friction products.
From a large number of endoprostheses, you can choose a suitable implant. Sometimes patients try to choose an implant on their own, studying brands, models, and varieties. Orthopedists often hear the following from patients:
- I recently read that the most reliable prosthesis is made of ceramics.
- A cemented denture is an outdated model, while a cementless one is a good option.
- The best prostheses are foreign ones, they have...
First myth, which should be dispelled - there is no best endoprosthesis.
Second- For replacement of the hip joint There are many variations of orthopedic designs: some of them are better, others are somewhat inferior in one way, but superior in another. We are talking about well-known companies that have been working in the orthopedic market for several years.
The most durable and expensive implant is with a ceramic friction pair. But this is not always the case: overweight and very active people do not need ceramics - it can crack under load.
There are inexpensive models, but there are also expensive prostheses. This does not mean that the cheaper option may be much worse and cause complications. When releasing a new model of an implant, the company is forced to raise its cost, since the development, production, Consumables require large investments. New models will take into account the shortcomings of the previous ones and will no longer contain them. It is possible that the service life will be longer.
This can cause ceramics to crack.
In the third case, it is necessary to take into account not only the quality of the prosthesis, but also the work of the surgeon. Even an expensive implant does not guarantee the success of the operation if the doctor is poorly qualified and has no experience in endoprosthetics. Therefore, it is worth focusing not only on models and companies, but also on the knowledge of the person who will operate on you. Don't forget the importance of rehabilitation. A full recovery course will guarantee a successful recovery with any type of prosthetic design.
The models of leading foreign companies do not differ much, so it is difficult to say which is better. Comparison - rather by price-quality standards. Well-known companies Zimmer, De-Puy, Biomet produce equivalent samples that do not have pronounced differences.
The ceramic head destroyed the acetabular component.
Second photo of the destruction.
When choosing a prosthesis, look not at the company or cost, but at more important feature, affecting the service life of the adaptation - friction pair.
Types of endoprostheses, their differences
If speak about appearance prosthesis is a complete imitation of a person’s native joint, withstanding everyday load and having the same functional abilities, which was previously destroyed.
Features and differences are distinguished by type of endoprosthetics:
- superficial. The hip joint head and acetabulum are being replaced;
- total. Complete replacement of damaged bone and cartilage with excision of the femoral neck.
An example of a surface implant from Zimmer.
Implants are distinguished by the method of attachment:
- Fixation without medical cement. Used for patients young no signs of osteoporosis. With good bone density, they grow into the prosthesis and secure it. For cementless fixation, a titanium alloy stem can be used.
- Fastening with cement. The technique is used in elderly people or in patients whose bone density does not allow the use of a cementless method.
Scheme of methods for fixing implants.
Recently you can often hear the term “liquid implant”. It is not related to full endoprosthetics, since it is not a prosthesis. It is assumed that certain types of acids will be introduced, the purpose of which is... Any specialist will tell you that this is impossible. Under the influence of the degenerative-dystrophic process, the pathological joint is completely destroyed and has no ability to regenerate. The only way out is surgery.
Metal-polyethylene, polyethylene-ceramics, ceramics-ceramics.
Let's consider friction pairs. There is no point in choosing a specific brand or focusing on price, but it makes sense to consider other characteristics, because wear products will negatively affect the surrounding soft tissue and bones. This is what you really need to discuss with your doctor.
The following varieties exist:
- metal combined with metal;
- metal and polyethylene;
- ceramics plus ceramics;
- combination of ceramics and polyethylene.
Each type has its own advantages and disadvantages. It cannot be said that a combination of some components will be bad and another will be good. The prosthesis, like friction pairs, are selected individually. What is not suitable for one patient may be recommended for another.
| Variety | Positive sides | Negative sides |
| Combination of ceramic and ceramic |
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| Metal combined with metal |
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| Metal and polyethylene |
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| Ceramics and polyethylene |
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A popular option is the combination of a metal component with a metal one due to the low price, but it is not recommended for installation by everyone - it has a number of limitations. It is often implanted in men who are accustomed to a more active lifestyle. It is strictly not recommended for women planning pregnancy in the future: there is high risk penetration of toxic products into the placenta, which negatively affects the fetus. In a number of countries, the use of this combination of components is prohibited.
Wear on metal components is visible to the naked eye.
Ceramics are more often used in combination with polyethylene: it is suitable for patients of any category and has no age restrictions. Revision intervention for replacement may be necessary after 15-20 years.
From 10 to 15% of complications after endoprosthetics are associated with incorrect selection of the prosthesis, and more specifically, the friction pair. That is why it is important to find a qualified orthopedist and pay attention not to the brand of the implant, but to its quality.
The longest service life is for the “ceramics plus ceramics” friction pair. Suitable for almost all patients, the only contraindication is such prostheses for osteoporosis ( low density tissues) are not implanted. The main condition that allows you to extend the duration of use and reduce the risk reoperation- correct installation of structural components.
Hip joint: price of prosthesis
And the implant itself depends on the orthopedic surgery medical center. The average according to 2014 statistics is 90,000-120,000 rubles. This price did not include hospital stay and diagnostic tests.
The price of orthopedic structures depends on the manufacturer and the material used. Foreign companies offer implants in the region of 1300-2000 dollars, domestic ones are several times cheaper.
The quality of endoprosthetics is affected not by cost, but by... Even the most expensive endoprosthesis does not guarantee a therapeutic effect if the intervention is performed incorrectly and there is no proper recovery period.
Where to buy a hip prosthesis?
You will purchase an implant to replace the hip joint directly with your doctor. They are the ones who collaborate with manufacturers and will be able to tell you how much a certain type costs.
You can buy a prosthesis yourself at specialty store or order online. The service is possible provided that you have discussed all the nuances in advance and found out the required type of prosthesis.
There are companies in Russian cities that are official distributors of foreign manufacturers of orthopedic implants. You can often hear about Legacy MED (working with the world famous American company Johnson & Johnson). Here you can buy titanium and ceramic endoprostheses. The consultant will tell you the exact price.
Dislocation of the hip prosthesis
The development of such a pathology as after replacement is a rare case, diagnosed no more than 2-4 times per 100 operated patients. The symptoms are no different from the dislocation before the replacement. The clinical picture is as follows:
- development of pain that cannot be relieved with painkillers;
- change in the length of the lower limb, its shortening;
- impaired range of motion, stiffness, a sharp decline physical activity.
The cause of dislocations is trauma, but they will help prevent this strong muscles, hips trained during rehabilitation.
To clarify the stability of the structure, the patient is put into a state of anesthesia, where the doctor deliberately subluxes the prosthesis and then resets it to its original position. This procedure allows us to predict the reasons that provoked the complication and reduce the risk of re-dislocation in the future.
Treatment consists of reduction of the dislocation and subsequent wearing of a special prosthesis, a course of physical therapy, physical therapy, and massage.
Zimmer: hip replacements
A well-known manufacturer of orthopedic equipment, a company founded in the USA more than a hundred years ago, is Zimmer. Throughout its existence, the company has constantly developed, introduced the latest technologies, created new designs and prostheses. Its products are transported to different countries of the world and used in medical centers in Israel, Russia, and the Czech Republic.
Such popularity is associated with the quality of the product: it is distinguished by durability and high adaptability.
Zimmer is the Mercedes of endoprostheses.
The company's assortment is wide, it is possible to choose a prosthesis in the price-quality ratio. Even inexpensive implants can completely imitate the native joint and have good wear resistance.
What kind of prosthesis can I buy and how long does it last? Production Zimmer produces the following implant structures:
- knee replacement prosthesis. The undisputed leader: almost half of the operations are performed using prostheses from this company. Service life - 15 years or more;
- endoprostheses for shoulder joint replacement. A unique innovative development - a joint with a maximum level of implantability, restoring hand function by 95%;
- implants for hip replacement. A large selection of types, there is the possibility of individual selection, including price.
The main difference between Zimmer products is the high adaptation of the prosthesis, which shortens the rehabilitation period.
According to statistics, artificial joints from this manufacturer, in 99% of cases they remain stable for 10-12 years after installation. In almost 85% of Zimmer's service life is close to 15-18 years. Therefore, such popularity of the company is quite justified.
Patients often ask the following question: is it possible to install our prostheses, how many years will they last? The quality of domestic manufacturers is not much worse; there are many worthy orthopedic companies. There are many factors to consider when answering another question. Here everything depends not on the price of the implant, but on the chosen design - a friction pair, the skillful hands of a doctor and a rehabilitator.Cost of hip joint
Occasionally complications develop afterwards; in 10% they are associated with an incorrectly selected implant. Patients are diagnosed with a neck fracture, development infectious process, swelling, hematomas.
Fact: there is no specific prosthesis - a universal model that could suit everyone and not cause side effects.
The main mistake many patients make is choosing an endoprosthetic design based on reviews from the Internet and price. A person chooses the most expensive foreign-made prosthesis and has the operation performed by a surgeon with little experience. As a result, adaptation is poor, recovery is long, and there are many complications.If you decide to undergo endoprosthetics, please note that the price of the implant, Zimmer or ceramic, has nothing to do with the success of the treatment. It makes sense to opt for an inexpensive but suitable orthopedic item.
An experienced surgeon has his own preferences in models and brands, so preliminary consultation and selection is extremely necessary. Specialists, both private institutions and government medical centers More often they advise choosing Zimmer and DePuy. Although the prostheses of these manufacturers have no fundamental differences, they are completely similar in appearance, they are high-quality products with the ability to choose a design taking into account financial capabilities.
How much does treatment with such endoprostheses cost? average price in Moscow - 200,000 rubles, including stay in a private clinic, laboratory research, hospital and subsequent rehabilitation under the supervision of a specialized doctor.
There is an important point in orthopedic surgery: the basis for a successful recovery is recovery. Not a single prosthesis, even the most expensive, guarantees the success of an operation without compliance.There are enough examples in practice where patients, having purchased the most innovative and expensive implant, completely ignored restoration, believing that due to the high price it was not necessary. The result was that patients returned to the doctor several years later with complaints of swelling and the development of lameness. Conservative treatment in this case it cannot be - a revision operation is prescribed, followed by additional expenses and long-term rehabilitation.
Very often, replacing a native joint with an artificial one is the only way to restore the normal functioning of the musculoskeletal system. Approach responsibly in choosing a prosthesis, diagnosis, clinic, doctor and further recovery.
Hip replacement is a serious orthopedic operation to replace a damaged joint with an implant. The basis for surgical intervention is usually increased wear and tear of the joint, as well as bruises and injuries in the area of the joints, which result in functional disorders. How much does endoprosthetics cost and which implant is better to buy? Advice and recommendations from orthopedic specialists will help you understand the issue of choosing the optimal types of modern endoprostheses.
When planning to buy an implant for yourself, you should not base it only on its cost level. In fact, a large number of zeros on the price tag is not always a guarantee of long and flawless service of the endoprosthesis. Its price depends on the type of model and the main diagnosis. For example, an implant for surgical treatment coxarthrosis is more expensive than the replacement needed for a hip fracture.
The combination of high cost and excellent quality in traumatology does not always look good. Since hip replacement is considered a complex operation, the main thing is the high level of its execution, and not the high cost of the implant. Medical error can negatively affect even the highest quality material. It would be correct if the patient entrusts the right to choose a prosthesis to a qualified surgeon. This is the main factor in successful endoprosthetics. An experienced specialist will be able to decide which type of artificial substitute is best to prefer in each specific case.
The most popular models of artificial joints are produced international companies DePuy and Zimmer. In addition, active participants modern market are the companies Stryker, Smith & Nephew, Biomet, Aesculap, B. Braun. Zimmer produces high quality Zimmer Trilogy cups. The DePuy brand is best known for its Pinnacle line of endoprostheses. In terms of purpose and workmanship, Zimmer and DePuy products are almost identical, so make a choice best option Only a professional doctor can.
Indications and restrictions
An operation to introduce an artificial organ is usually prescribed in the presence of certain types of diseases and negative conditions of the hip joint:
- femoral neck fracture and consequences of traumatic injuries;
- coxarthrosis (deforming osteoarthritis) and other types of arthritis that cause degenerative changes;
- dysplasia;
- impaired blood supply to the femoral head;
- congenital anomalies;
- some types of tumors;
- aseptic necrosis.
The presence of any of the listed signs is not a mandatory indicator for surgical intervention. In each individual case, the issue of endoprosthetics for the patient is decided by the attending physician after a thorough examination. In particular, for coxarthrosis, surgery is prescribed only for stages 2-3 of the disease. An endoprosthesis is also installed for unbearable long-term pain in the hip joint, which does not respond to treatment for six months.
The following circumstances may serve as contraindications to surgery to replace a joint with an endoprosthesis:
1. dermatological diseases and damage to the skin in the thigh area;
2. problems with peripheral vessels of the lower extremities;
3. paralysis of the quadriceps muscle;
4. oncological diseases;
5. severe mental disorders;
6. excess body weight (more than 120 kg).
When deciding whether to install an endoprosthesis, the age and general health of the patient must be taken into account. Orthopedic surgery is not recommended for young people in cases where it is possible to preserve/restore functions with the help of drug treatment.
What to consider when purchasing?
Externally, the artificial joint is very similar to the real one. In the classic version, it consists of a pin (leg), a cup and a head. The endoprosthesis takes on the usual physical exercise and performs the same actions as a healthy organ. The operation to replace a damaged hip joint with an implant is called primary hip replacement. When it comes to revision arthroplasty, it means replacing a previously installed joint.
There are many types of prostheses on sale, which are classified according to several criteria.
1. Type of construction.
- Unipolar - replacing the head of the hip joint.
- Bipolar - prostheses that are installed instead of the femoral head and acetabulum. This kind of endoprosthetics is called total. It is often performed in orthopedics and traumatology.
2. Main material (cup and stem).
- Metal and metal are a wear-resistant combination that can last at least two decades. Metal endoprostheses are best installed for men leading an active lifestyle. Thanks to the large joint heads, a wide range of motion is possible. For women planning a pregnancy, prostheses are not recommended due to the high likelihood of metal ions entering the fetus. The disadvantages include the high price of the endoprosthesis. In addition, toxic products are formed as a result of friction of artificial surfaces. According to orthopedists, metal joints are rarely used in practice, and in some countries they are even prohibited.
- Metal and plastic are an inexpensive option with moderate toxicity of abrasion products. The combination of materials is considered the most short-lived (10-15 years). Such a prosthesis can be purchased by people of a non-athletic nature with a measured and calm lifestyle. Due to their low cost, implants are available to patients of retirement age.
- Ceramic and ceramic artificial joints are equally suitable for patients of any gender and age. They are durable and non-toxic. The main obstacle to purchasing a ceramic endoprosthesis is high price. In addition, implants can creak during movement, which creates significant discomfort for patients.
- Ceramics and plastic are the cheapest types of prostheses. The combination is characterized by rapid wear and fragility, therefore it is more suitable for elderly patients of both sexes.
3. Method of fixation.
- Cementless/mechanical – installation of endoprosthesis elements into bone tissue by wedging or pressing. The connection points are covered special composition. Thanks to this coating, bone“fuses” with the endoprosthesis material (usually titanium), securely fixing it. Uncemented dentures are good for young patients. This facilitates future revision hip replacement surgery.
- Cemented - all parts of the dentures are fixed using a special biological solution. This connection method ensures reliable fixation even with osteoporosis. Cemented endoprostheses are best installed in elderly patients and people with reduced physical activity.
- Hybrid-full - individual parts of the prosthesis can be made from different types materials. The cup is fixed using a cementless method. Artificial legs are secured with a solution. Hybrid endoprostheses are best recommended for middle-aged patients.
Price overview
In fact, the cost of endoprosthetics consists of two parts. This is the price of the implant itself and the cost of the operation along with the stay in the inpatient department. Depending on the type and manufacturer, an endoprosthesis costs from 60,000–80,000 to 220,000–300,000 rubles. On average, an implant costs 130,000 – 150,000.
The average cost of hip replacement surgery in Russian clinics is 170,000–250,000. The total amount depends on the conditions of stay and the duration of hospitalization. In total, endoprosthetics together with hospital stay costs an average of 350,000–370,000 (30,000–220,000 for single-pole prosthetics, 400,000–600,000 rubles for total). IN different countries it is estimated at $8,000 to $40,000.
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