Complications after hip replacement surgery. Complications after hip arthroplasty symptoms Temperature after hip arthroplasty

• Risk factors
• Possible Complications
• Pain after hip replacement

Hip arthroplasty is an operation to replace the affected joint with an endoprosthesis. As with any other surgery, complications can occur. This is due to the individual characteristics of the organism, the state of health and the complexity of the operation.

Pain after arthroplasty is inevitable. This is due to the nature of the operation.

Risk factors

• The advanced age of the patient.
• Associated systemic diseases.
• Past operations or infectious diseases of the hip joint in history.
• The presence of acute trauma of the proximal femur.

Many patients are afraid to undergo surgery due to possible complications.

Possible Complications

Rejection of a foreign body (implant) by the body

This consequence occurs extremely rarely, because Usually, before the operation, after choosing the prosthesis, tests are carried out for individual sensitivity to the material. And if there is intolerance to the substance, then another prosthesis is selected.

The same applies to allergic reactions to anesthesia or the material from which the prosthesis is made.

Infection in the wound during surgery

This is a serious condition that is treated for a long time with antibiotics. Infection can occur on the wound surface or in the depth of the wound (in soft tissues, at the site of the prosthesis). The infection is accompanied by symptoms such as swelling, redness, and pain. If treatment is not started in time, then the prosthesis will need to be replaced with a new one.

Bleeding

It can begin both during the operation and after it. The main reason is medical error. If help is not provided in time, then the patient, at best, may need a blood transfusion, at worst, hemolytic shock and death will occur.

Prosthesis displacement

Change in leg length

If the prosthesis has not been fitted correctly, the muscles near the joint may weaken. They need to be strengthened, and exercise is the best way to do this.

The risk of complications is reduced with proper rehabilitation after arthroplasty surgery

Deep vein thrombosis

After a decrease in motor activity in the postoperative period, blood stasis may occur, and as a result, the occurrence of blood clots. And then it all depends on the size of the blood clot and where it will be carried by the blood stream. Depending on this, the following consequences may occur: pulmonary thromboembolism, gangrene of the lower extremities, heart attack, etc. To prevent this complication, it is necessary to start active activities at the appointed time, and anticoagulants are prescribed on the second day after the operation.

Also, over time, the following complications may occur:

• Weakening of the joints and disruption of their functioning.
• Destruction of the prosthesis (partial or complete).
• Dislocation of the endoprosthesis head.
• Lameness.

These complications after hip arthroplasty occur less frequently and over time. To eliminate them, you need surgery (replacement of the endoprosthesis).

Pain after hip replacement

The only complication that will accompany arthroplasty under any conditions is pain.

To get to the joint, it is necessary to cut the fascia and muscles of the thigh. After stitching, they will grow together for about 3-4 weeks. When performing movements, pain will occur. And since the movements are mandatory so that the muscles grow together faster and correctly, the pain will be felt for almost the entire period of rehabilitation.

Endoprosthetics is a serious operation. After it, certain complications are possible, but with timely diagnosis and treatment, everything can be eliminated without unnecessary harm to health.

MoyaSpina.ru

Pain after hip arthroplasty: causes and treatment

Hip arthroplasty is the replacement of a damaged joint element with an artificial implant.

Such an operation is prescribed for various reasons, it can be complex diseases of the hip joint or its injuries.

After arthroplasty, the patient must follow certain recommendations.

Indications for prosthetics

Most often, arthroplasty is prescribed in the following situations:

1. Trauma to the femoral neck (usually fractures).
2. Severe, advanced stages of rheumatoid arthritis.
3. The presence of aseptic necrosis of the head (avascular necrosis).
4. development of hip dysplasia.
5. Severe stages of coxarthrosis.

The need for an implant may arise as a result of post-traumatic complications, for example, with arthrosis. The life of the patient after arthroplasty changes, as a number of recommendations appear that must be strictly followed.

There are some restrictions, the patient must perform a complex of special physiotherapy exercises. At first, the patient is forced to use crutches.

The duration of the postoperative period and full recovery entirely depend on the general condition of the patient, his age and numerous other factors. In order to avoid possible complications from hip arthroplasty, the patient must be disciplined in following the recommendations of the attending physician.

The complex of therapeutic exercises, which is necessary for the restoration of the hip joint, must be performed under the supervision of an instructor with a medical qualification. Life in the new mode will bring the moment of full recovery much closer, thanks to which the patient will be able to start walking much faster without the help of crutches. It can also be noted that rehabilitation after hip arthroplasty can continue at home.

After endoprosthetics, pain, as a rule, is pronounced. It is strictly forbidden to take any measures on your own, otherwise you can get serious complications.

The main indications for endoprosthesis surgery are the symptoms that accompany the disease and the results of clinical and radiological studies. The symptoms indicated by the patient are the most significant factor that is an indication for surgery.

In some situations, despite the fact that coxarthrosis is in the last stage of its development (this is clearly demonstrated by x-ray examination), a person is not worried about pain and other symptoms of the disease. This pathology does not require surgical intervention.

Modern hip endoprosthesis - its features

Modern orthopedics in its development has greatly succeeded. A feature of today's endoprosthesis is a complex technical structure. The prosthesis, which is fixed in the bone without cement, consists of the following elements:

• leg;
• Cup;
• head;
• insert.

The endoprosthesis, which is fixed with cement, differs from the previous one in the integrity of the acetabular element.

Each component of the implant has its own parameters, so the doctor must determine the size that is ideal for a particular patient.

Endoprostheses differ from one another in the way of fixation. Exists:

1. Cement fixation.
2. The fixation is cementless.
3. Combined fixation (a hybrid of the first two).

Since reviews of different types of endoprosthesis are mixed, it is necessary to collect as much information about the implant as possible before hip replacement surgery.

The endoprosthesis can be unipolar or total. The use of one or another artificial joint depends on the number of elements that need to be replaced. The implementation of interaction in the endoprosthesis is called "friction pair".

How long an artificial hip joint implant can serve depends entirely on the quality of the material from which the endoprosthesis is made.

How is arthroplasty performed?

The process of hip replacement is performed by two teams - anesthesia and operating room. The operating room team is led by a highly qualified practicing surgeon. In the photo you can see the place where the doctor makes an incision to remove and replace the joint.

The duration of the hip arthroplasty operation lasts on average 1.5-2 hours. The patient at this time is under anesthesia or spinal anesthesia, so he does not feel pain. Intravenous antibiotics are required to rule out infectious complications.

After arthroplasty, the patient remains in the intensive care unit for some time, under constant medical supervision. Over the next seven days, the patient continues to receive drugs that prevent blood clotting and antibiotics.

In order to maintain a certain distance between the legs, a pillow is placed between them. The patient's legs should be in the retracted position.

Body temperature after hip arthroplasty is often unstable. For some time the patient feels pain, so he is given anesthetics.

It is impossible to predict in advance how long the recovery period after arthroplasty will take. In order for the rehabilitation process to go much faster, the patient must be disciplined and must follow all the recommendations of the attending physician.

Recommendations to be followed for the rest of life The patient should begin to move the very next day. And this is done without getting out of bed. Right on the bed, the patient can move and perform therapeutic exercises.

To fully restore mobility in the hip joint, it is necessary to constantly work on its development. In addition to the course of physiotherapy exercises, the patient is shown breathing exercises.

Most often, the patient can walk already on the third day of rehabilitation, but he must use crutches. After a few days, doctors will remove the stitches. After the operation to implant an artificial implant, the sutures are removed on the 10th, 15th day. It all depends on how soon the patient gets better.

Many patients ask themselves: upon arrival home, how to live on? After all, in the hospital they were under the vigilant supervision of doctors and staff, and the entire recovery process was under control.

Indeed, life with an endoprosthesis is somewhat different from the life that preceded endoprosthesis. It has already been said above that you need to constantly work on an artificial hip joint.

The patient should move as much as possible, but overwork and pain in the hip should not be allowed. A huge role in the recovery process is played by therapeutic exercises, but a set of exercises should be compiled by a doctor who takes the patient's medical history.

Returning home, the patient must work hard on the new joint, otherwise the recovery period can stretch for a long time.

If the patient does not want serious complications to arise after the operation and pain to recur after returning home, he must follow a number of recommendations.

1. Full bending of the artificial joint must not be allowed.
2. In the “sitting” position, it is impossible for the knees to be in the same plane with the hips, they should be located lower. Therefore, it is recommended to put a pillow on the chair.
3. Whatever position the patient is in, he should not cross his legs.
4. When getting up from a chair, the back should remain straight, you can not lean forward.
5. Crutches should be used until the doctor cancels them.
6. Walking in the first days after arthroplasty is possible only with the help of medical staff.
7. Shoes should be as comfortable as possible, so heels are contraindicated.
8. When visiting another doctor, he must be informed that the hip joint is artificial.

Hip replacement requires work not only on the joint itself, the patient must always and everywhere take care of his general state of health. If there is pain in the area of ​​the thigh in which the artificial implant was implanted, accompanied by an increase in body temperature, you should immediately contact your doctor.

Most likely, in the end, many of these recommendations can be abandoned. This will depend on how long it takes the patient to fully recover. Usually seven to eight months are enough for rehabilitation.

The patient should be informed that an artificial hip implant, like any mechanism, has its own lifespan. Therefore, over time, the endoprosthesis wears out. On average, its validity period lasts 10-15 years and depends on certain conditions and features.

If the endoprosthesis fails quickly, it is likely that it has been misused. Any active sports are contraindicated for a patient with an artificial hip prosthesis.

While doing physical therapy at home, the patient must be aware that ignoring the doctor's recommendations can provoke serious complications. Physical therapy exercises do not have to be difficult and cause pain. It is impossible to allow large loads on the artificial joint.

sustav.info

Pain and complications after hip arthroplasty

The operation to replace the hip joint allows a person to return to a full life and say goodbye to those arthrosis symptoms that prevented him from experiencing life's joys for many years in a row. Studies show that complications after hip arthroplasty develop in 1% of young people and 2.5% of older patients. All this is true, but you should not relax! Despite the meager likelihood of developing negative consequences, an unpleasant situation can affect anyone, and especially those who did not strictly follow the rehabilitation program.

Image of the position of the endoprosthesis in the human body.

As a rule, complications after hip arthroplasty are caused by improper postoperative care and non-compliance with the regime of physical activity after discharge from the hospital. The second reason for poor prognosis, which happens much less often, is the errors of the surgeon. Thus, the well-being of the overall treatment event is affected by the status of the medical institution and the qualifications of the medical staff, where, in fact, the patient was operated on, observed and received high-tech medical care - surgical and rehabilitation treatment.

The pain is different, there is the right one - after moderate physical exertion. And there is an acute one, talking about problems that need to be urgently diagnosed.

Complication statistics in percent

The operation to install a hip joint prosthesis today enjoys tremendous success, since in modern orthopedics it is the only effective method that “puts” the patient on his feet, relieves debilitating pain and limited ability to work, and allows you to return to healthy physical activity. Unpleasant pathological situations associated with implantation occur infrequently. However, they were recorded in isolated cases, about which the patient should be informed. According to ongoing randomized controlled trials, the following data have been obtained on the most common problems:

• dislocation of the head of the prosthesis develops in approximately 1.9% of cases;
• septic pathogenesis - in 1.37%;
• thromboembolism - in 0.3%;
• periprosthetic fracture occurs in 0.2% of cases.

Often they develop not through the fault of the surgeon, but the patient himself, who did not deign to continue rehabilitation at a specialized medical institution or did not adhere to a special physical regimen after the recovery was completed. Deterioration often occurs already at home, when there is no that careful control by doctors that was in the clinic.

If you have had an operation, enough time has passed, but the leg cannot repeat the amplitude of movement of a healthy limb, then this is the result of a lack of rehabilitation.

Prediction of possible complications, drug and non-drug control, mandatory early prevention of concomitant diseases, the use of adequate tactics of surgical intervention and a competent rehabilitation program can significantly minimize the likelihood of postoperative consequences.

Attention! In exceptional situations, despite all the precautions and safety measures taken, undesirable postoperative phenomena may occur. Not a single orthopedic specialist, even with rich and impeccable work experience, can 100% predict how a particular organism will behave after such complex manipulations on the musculoskeletal system, and give the patient a complete guarantee that everything will go smoothly and without excesses.

Differentiation of pain: normal or not

Pain after hip arthroplasty will be observed in the early period, because the body has experienced a serious orthopedic operation. Painful syndrome during the first 2-3 weeks is a natural response of the body to a recent surgical injury, which is not considered to be any deviation.

Until the surgical injury heals, the muscle structures will not return to normal, and they, oh, how they suffered from the past illness, until the articular bones together with the endoprosthesis become a single kinematic link, the person will experience discomfort for some time. Therefore, at the initial stage of recovery, a good anesthetic is prescribed, which helps and makes it easier to endure early painful symptoms, and it is better to concentrate on treatment and rehabilitation classes.

Well healing suture after surgery. It is even, pale and has no discharge.

However, it should be understood that even with all complications after hip arthroplasty, the symptom of pain that manifests itself at the site of the implanted prosthesis may signal an already existing serious danger. Therefore, pain sensations should be professionally differentiated: which of them is the norm, and which is a real threat. And this, as it is easy to understand, is in the competence of only a qualified specialist. The task of the patient is to immediately notify the orthopedist in case of any uncomfortable signs.

Important! If pain increases after hip arthroplasty or there is no positive dynamics in reducing the pain factor at any stage, this should be reported to the specialist immediately! Since there is a high probability that they indicate the onset or already progression of dangerous complications. The doctor will identify what causes pain after hip arthroplasty, establish the exact cause of postoperative pathogenesis and take emergency measures to eliminate it.

Main Risk Factors

Like any surgical intervention, hip replacement does not exclude complications, and quite serious ones. Especially if mistakes were made in the intra- and / or post-operative period. Even small errors during surgery or during rehabilitation increase the likelihood of unsatisfactory hip arthroplasty. In addition, there are also so-called risk factors that increase the body's predisposition to postoperative consequences and often become their cause, they include:

• advanced age of a person;
• severe concomitant disease, for example, diabetes mellitus, arthritis of rheumatoid etiology, psoriasis, lupus erythematosus and other systemic ailments;
• any previous surgical intervention on the "native" joint, aimed at the treatment of dysplasia, femoral fractures, coxarthrosis deformities (osteosynthesis, osteotomy, etc.);
• re-endoprosthetics, that is, repeated replacement of the hip joint;
• local inflammation and purulent foci in the patient's history.

It should be noted that after the replacement of the hip joints, older people, and especially those over 60, are more susceptible to complications. , for example, to reduce resistance to infection. In addition, due to physiological changes in the body due to age, people of advanced years have a reduced potential for reparative and regenerative functions, weakness of the muscular-ligamentous system, osteoporotic signs, and a certain degree of lymphovenous insufficiency of the lower extremities.

It is more difficult for older people to recover, but this is also done successfully.

Replacement of a non-viable hip joint and complications in the above problems, as shown by clinical experience, have a direct relationship. But this does not mean at all that hip replacement is contraindicated for the older generation. No, in most cases it is allowed, because it is for such people that such intervention is most often necessary. It’s just that a specialist should take into account the health indicators of the ward to the smallest detail and take all the necessary measures so that arthroplasty and recovery go smoothly for him. However, such a competent approach is practiced in all highly professional clinics, and for absolutely every patient, regardless of age.

The concept and methods of treating the consequences

Complications after hip arthroplasty, symptoms for better perception will be presented in the table below, should be detected in a timely manner. A quick visit to the doctor at the first suspicious signs will help to avoid the progression of adverse events, and in some situations, save the implant without resorting to revision surgery. It is important to understand that the more neglected the clinical picture becomes, the more difficult it will be for therapeutic correction.

It is impossible to talk about the symptoms until it becomes clear what the complications after hip arthroplasty are in general. So, we will explain the concepts of the main types of pathogenesis, the causative factor of occurrence and ways to eliminate them.

Dislocations and subluxations of the endoprosthesis

As a rule, a negative excess occurs in the first year after prosthetics. This is the most common pathological condition in which there is a displacement of the femoral component in relation to the acetabular element, resulting in separation of the head and cup of the endoprosthesis. The provocative factor is excessive loads, errors in the selection of the model and installation of the implant (defects in the setting angle), the use of posterior surgical access, injuries.

Dislocation of the femoral component on x-ray.

It should be noted that the risk group includes people with hip fractures, dysplasia, neuromuscular pathologies, obesity, joint hypermobility, Ehlers syndrome, patients older than 60 years. Also particularly vulnerable to dislocation are individuals who have undergone surgery on a natural hip joint in the past. The dislocation needs non-surgical reduction or an open method. With timely treatment, it is possible to set the endoprosthesis head in the vast majority of cases by a closed method under anesthesia. If the problem starts, the doctor may prescribe a second operation to reinstall the endoprosthesis.

paraprosthetic infection

The second most common adverse event, characterized by the activation of severe purulent-inflammatory processes of an infectious nature in the area of ​​the implant. Infectious antigens are introduced intraoperatively through insufficiently sterile surgical instruments (rarely) or, after intervention, they move along the bloodstream from any problematic organ that has a pathogenic microbial environment (often). Poor treatment of the wound area or poor healing (in diabetes) also contributes to the development and reproduction of bacteria.

Discharge from the surgical wound is a bad sign.

The purulent focus adversely affects the strength of the fixation of the endoprosthesis, causing it to loosen and become unstable. Pyogenic microflora is difficult to treat and, as a rule, involves the removal of the implant and re-installation after a long time. The main principle of treatment is a test to determine the type of infection, long and expensive antibiotic therapy, abundant lavage of the wound with antiseptic solutions.

The arrows indicate the zones of infectious inflammation, this is how they look on the X-ray.

Thromboembolism (TELA)

PE is a critical blockage of the branches or main trunk of the pulmonary artery by a detached thrombus, which was formed after implantation in the deep veins of the lower limb due to low blood circulation resulting from limited leg mobility. The culprits of thrombosis are the lack of early rehabilitation and the necessary medical treatment, a long stay in an immobilized state.

With this complication, they are quite successfully working at this stage of the development of medicine.

Blocking the lumen of the lungs is dangerously fatal, so the patient is immediately hospitalized in the intensive care unit, where, given the severity of the thrombotic syndrome, qualified assistance is provided: the introduction of thrombolytics and drugs that reduce blood clotting, NMS and mechanical ventilation, embolectomy, etc.

Periprosthetic fracture

This is a violation of the integrity of the femur in the area of ​​fixation of the leg with an unstable and stable prosthesis, which occurs intraoperatively or at any time after the surgical session (in a few days, months or years). Fractures more often occur due to reduced bone density, but may be the result of incompetent development of the bone canal before installing an artificial joint, an incorrectly chosen method of fixation. Therapy, depending on the type and severity of damage, consists in using one of the methods of osteosynthesis. The leg, if necessary, is replaced with a corresponding part that is more suitable in configuration.

Implant failure is very rare.

neuropathy

Neuropathic syndrome is a lesion of the peroneal nerve, which is part of the structure of the greater sciatic nerve, which can be triggered by lengthening of the leg after prosthetics, pressure of the resulting hematoma on the nerve formation, less often by intraoperative damage due to careless actions of the surgeon. Restoration of the nerve is carried out through etiological treatment with the optimal method of surgery or through physical rehabilitation.

When an inexperienced surgeon works, there is a risk of traumatizing the femoral nerves, which entails constant pain after surgery.

Symptoms in the table

Syndrome	Symptoms
Dislocation (violation of congruence) of the prosthesis	Paroxysmal pain, muscle spasms in the hip joint, aggravated by movement; in a static position, the severity of pain is not so intense; forced specific position of the entire lower limb; over time, shortening of the leg occurs, lameness appears.
Local infectious process	Severe pain, swelling, redness and hyperthermia of soft tissues over the joint, discharge of exudate from the wound; an increase in the general body temperature, the inability to step on the foot due to pain, impaired motor functions; purulent discharge from the wound, up to the formation of a fistula, is observed in advanced forms.
Thrombosis and PE (thromboembolism)	Venous congestion in a diseased limb can be asymptomatic, which may have an unpredictable detachment of a blood clot; with thrombosis in varying severity, swelling of the limb, a feeling of fullness and heaviness, pulling pains in the leg (increased by load or change of position) are traced; PE is accompanied by shortness of breath, general weakness, loss of consciousness, and in the critical phase - blueness of the skin of the body, suffocation, up to death.
Periprosthetic bone fracture	Acute pain attack, rapidly growing local edema, redness of the skin; crunching when walking or probing the problem area; severe pain when moving with an axial load, soreness of soft structures on palpation; deformity of the leg and smoothness of the anatomical landmarks of the hip joint; impossibility of active movements.
Neuropathy of the tibial nerve	numbness of the limb in the area of ​​​​the thigh or foot; weakness of the ankle (drop foot syndrome); inhibition of motor activity of the foot and toes of the operated leg; the nature, intensity and location of pain can be variable.

Preventive measures

Complications after hip replacement are much easier to prevent than to deal with time-consuming and lengthy treatment to get rid of them. The unsatisfactory development of the situation can simply nullify all the efforts of the surgeon. In addition, the therapy of a pathological condition does not always give a positive effect and the expected result, therefore, leading clinics provide a comprehensive perioperative program for the prevention of all existing consequences. It begins to act from the first days of the patient's admission to the medical center.

Infections are treated with antibiotics, which in itself is quite harmful to the body.

At the preoperative stage, a comprehensive diagnosis is performed for the presence of infections in the body, diseases of internal organs, allergies, etc. If inflammatory and infectious processes, chronic diseases in the decompensation stage are detected, surgical measures will not begin until the identified foci of infections are cured, venously - vascular problems will not be reduced to an acceptable level, and other ailments will not lead to a state of stable remission.

Currently, almost all implants are made from hypoallergenic materials.

If there is a predisposition to allergic reactions, this fact is qualitatively investigated and taken into account, since the choice of medicines, endoprosthesis materials and the type of anesthesia depends on it. Moreover, the entire surgical process and further rehabilitation are built on the assessment of the health status of internal organs and systems, age criteria, weight and other individual characteristics. In order to minimize the risks of complications after hip replacement to the limit, prophylaxis is carried out before and during the procedure, after surgery, including the long-term period. An integrated preventive approach is based on the implementation of such measures as:

• drug elimination of the infectious source, full compensation of chronic ailments;
• appointment for 12 hours of certain doses of low molecular weight heparins to prevent thrombotic events, antithrombotic therapy continues to be carried out for some time after surgery;
• the use of a couple of hours before the upcoming replacement of the TBS and for several days of broad-spectrum antibiotics that are active against a wide group of pathogens;
• technically impeccable surgical intervention, while with minimal trauma, preventing significant blood loss and the appearance of hematomas;
• selection of an ideal prosthesis design that fully matches the anatomical parameters of a real bone joint, including its correct fixation at the correct orientation angle and in the most advantageous way, which in the future guarantees the stability of the implant, its integrity and excellent functionality;
• early activation of the ward in order to prevent stagnant processes in the leg, muscle atrophy and contractures, inclusion from the first day of exercise therapy and physiotherapy procedures (electromyostimulation, magnetic therapy, etc.), breathing exercises, as well as high-quality care for the surgical wound;
• informing the patient about all possible complications, permitted and unacceptable types of physical activity, precautions and the need to regularly perform physical therapy exercises.

A huge role in successful treatment is played by the communication of the patient with the doctor or other medical personnel. This is what is called a service, because when a patient is fully instructed, he better perceives the processes taking place with his body.

The patient must be aware that the outcome of the operation and the success of recovery depend not only on the degree of professionalism of the doctors, but also on himself. After prosthetics of the hip joint, it is possible to bypass unwanted complications, but only with the impeccable observance of the recommendations of specialists.

Advice! In order to protect yourself from the development of negative processes to the maximum, it is imperative to undergo a full-fledged rehabilitation course in a good medical institution that directly specializes in the direction of restoring people after joint replacement.

msk-artusmed.ru

How to get rid of pain after arthroplasty

Joint pain will disappear in a few days. Write down grandma's recipe...

Endoprosthetics of the hip joints is a surgical intervention, the purpose of which is to replace the affected joint with a special prosthesis. The operation is considered quite complicated, and various complications can often occur after arthroplasty. They can be characterized by pain in the hip joint.

Pain almost always occurs after surgery. This is due to the peculiarities of endoprosthetics.

Possible complications causing pain

Complications that can occur after arthroplasty cause severe pain. These include:

1. Rejection of the implant by the body;
2. Penetration of infection into the wound during surgery;
3. Implant displacement;
4. Deep vein thrombosis;
5. bleeding;
6. Change in leg length.

Rejection of the installed prosthesis is rare, since individual tissue sensitivity testing to the material of the prosthesis is usually performed before the operation. In cases where the material is not suitable. It is being replaced and retested. The procedure is performed until the material corresponding to the cells of the body is selected.

When an infection enters the wound, not only pain is observed, but also noticeable swelling and redness of the skin at the site of the suture. To eliminate this complication, antibiotics will be required. The source of infection may be on the surface of the wound or inside it, for example, where an articular prosthesis is installed.

Displacement of the hip implant may occur due to violations of the activity regimen and recommendations after surgery. For example, it is strictly forbidden to cross your legs or lift them high. Displacement can cause severe pain and discomfort.

Stagnation of blood due to a decrease in motor activity can cause blood stagnation, which develops into deep vein thrombosis. The consequences are not only severe pain, but also the occurrence of such serious diseases as a heart attack, gangrene of the lower extremities.

OUR READERS RECOMMEND! To eliminate pain in the joints, our readers advise Reliable remedy for pain "RECIPE GOR". The composition of the drug includes only natural ingredients and substances with maximum efficiency. The remedy "RECIPE GOR" is absolutely safe. It has no side effects.

Doctors opinion...

Bleeding can occur not only during the operation, but also after it. In this case, pain occurs quite rarely.

Improper installation of the prosthesis weakens the muscles that are located in close proximity to the joint. This can cause a sensation of change in leg length and mild pain.

Pain after arthroplasty, which is considered to be the norm

Pain is the only complication after arthroplasty that accompanies the postoperative period in any case. This is due to the numerous muscle incisions that are made to provide access to the joint.

When the tissues grow together, pain occurs in the area of ​​the hip joint, which can last about 3-4 weeks. If you follow the recommendations after arthroplasty and regularly perform the necessary movements, you can achieve the fastest elimination of pain.

What can be done to reduce pain and eliminate it completely?

In order to try to reduce the duration of pain and completely get rid of them, first of all, it is necessary to establish their cause. To do this, you should contact a specialist who will prescribe the necessary examination of the replaced hip joint in order to diagnose the causes that caused the pain.

If the pain is provoked by complications of arthroplasty, then their nature of occurrence is clarified and competent treatment is prescribed. In cases where pain is caused by the postoperative period, experts give recommendations for their quick elimination:

1. Follow all the recommendations of a specialist in motor activity and rest after the operation;
2. Perform a complex of therapeutic exercises;
3. Do not make sudden movements, do not raise your legs high and do not cross them;
4. Avoid stagnation of blood in the tissues in the area of ​​the hip joint;
5. Use crutches for the first time;
6. If you experience discomfort and increasing pain in the hip joint, immediately contact a specialist.

Conclusion

In conclusion, we can say that pain after arthroplasty may have a different nature of origin. It is very important to accurately establish their nature and causes. In cases with postoperative pain, which is a normal manifestation of the body, you should follow all the recommendations of a specialist in order to eliminate them in the near future.

DO YOU STILL THINK IT IS HARD TO GET RID OF JOINT PAIN?

Judging by the fact that you are now reading these lines, victory in the fight against joint pain is not yet on your side ... Constant or periodic pain, crunching and palpable pain during movement, discomfort, irritability ... All these symptoms are familiar to you firsthand.

But perhaps it is more correct to treat not the consequence, but the cause? Is it possible to get rid of pain in the joints without serious consequences for the body? We recommend reading the article by DOCTOR OF MEDICAL SCIENCES, PROFESSOR BUBNOVSKY SERGEY MIKHAILOVICH about modern methods of getting rid of joint pain... Read the article >>

systavi.ru

Complications after hip replacement

New medical discoveries have made it possible to restore the activity of the lower extremities due to hip replacements. This procedure helps to get rid of debilitating pain and discomfort, restores the functioning of the legs and helps to avoid disability. But sometimes there are various complications after hip arthroplasty. Pathologies can develop due to a medical error, infection, non-engraftment of the prosthesis, improper restoration procedures.

Common complications after hip arthroplasty

The operation to replace the hip joint of patients with an artificial one has been carried out for more than thirty years with great success. Such an intervention is especially in demand after hip (neck) fractures, damage to the musculoskeletal system, when the cup wears out due to age-related changes. Regardless of the cost of hip replacement surgery, complications are rare. But with untimely treatment of problems, the patient is threatened with disability, immobility of the lower extremities, and with a pulmonary embolism (thromboembolism) - death.

Conventionally, all the causes of the consequences and difficulties of the postoperative period after such prosthetics are divided into several groups:

• caused by non-perception of the implant by the body;
• negative reaction to a foreign body;
• allergy to the material of the prosthesis or anesthesia;
• infection during surgery.

Complications after hip replacement negatively affect not only the hip area, but also affect the general physical, psychological state, physical activity and ability to walk. To restore the former health, it is necessary to undergo a series of rehabilitation measures, which are prescribed based on the developed pathologies and problems. For a quick and effective recovery, it is necessary to establish the causes of complications and limitations after hip arthroplasty.

General complications

The development of the medical industry does not stand still, every year there are hundreds of discoveries that can change lives, give a chance to many patients. But complications after surgery are not uncommon. During hip arthroplasty, in addition to specific difficulties, general pathologies may occur:

• Allergy to medications that were used before or during surgery. For example, anesthesia.
• Deterioration of the work of the heart muscle (an operation is always a burden on the heart), which can provoke attacks and diseases of the cardiovascular system.
• Violation of motor activity, which is provoked by the non-perception of a foreign body by the body or an allergy to the implant material (for example, ceramics).

Infection in the area of ​​operation

Often, during a hip arthroplasty operation, such a complication occurs as infection of the soft tissues at the site of the incision or the implant itself. What is the danger of an infectious lesion:

• There are severe pains in the field of surgical intervention and placement of the endoprosthesis.
• At the site of the incision, suppuration, swelling and discoloration of the skin are observed.
• Septic instability of the new joint can become critical, which leads to a violation of the motor function of the lower extremities.
• The formation of a fistula with purulent discharge, which is especially often observed if timely treatment is not started.

So that complications after hip arthroplasty do not nullify the efforts during the operation, it is necessary to select and start treatment in a timely manner. Taking special antibiotics and using temporary spacers (implants) will help get rid of the infection. The treatment process will be long and very difficult, but the result will please the patient.

Pulmonary embolism

The most dangerous complication that can develop after the installation of an artificial joint (endoprosthesis) is pulmonary embolism. The formation of blood clots is often provoked by the immobility of the leg, which leads to impaired blood circulation in the lower extremities. This disease often ends in death, so you need to take preventive measures, for example, take anticoagulants, which the doctor prescribes for several postoperative weeks.

blood loss

Bleeding may occur during hip replacement surgery or shortly thereafter. The reasons are a medical error, careless movement or abuse of medications that thin the blood. In the postoperative period, anticoagulants are prescribed to prevent thrombosis, but sometimes such caution can play a cruel joke, turning preventive measures into a source of trouble. The patient may need a blood transfusion to replenish supplies.

Dislocation of the head of the prosthesis

One of the complications after hip arthroplasty is dislocation of the prosthesis head. This complexity is caused by the fact that the endoprosthesis is unable to completely replace the natural joint and its functionality is much lower. Falls, improperly performed rehabilitation, performing complex exercises or sudden movements can provoke a dislocation, which will lead to complications. As a result, the work of the musculoskeletal system, the activity of the lower limb will be disrupted.

To avoid complications after arthroplasty, one should be extremely careful in movements in the postoperative period: do not turn the leg too much inward, its flexion in the hip joint should not be more than 90 degrees. Revision hip arthroplasty will help to eliminate the complication, and for complete healing, it will be necessary to completely immobilize the leg for some time.

Loosening of the endoprosthesis design

As a result of vigorous activity, movements of the legs, loosening of artificial joints occurs. This negatively affects the condition of the bone tissue. Loosening causes destruction of the bone where the endoprosthesis is inserted. Subsequently, such instability of the prosthetic site can lead to a fracture. The only option to prevent loosening is to reduce motor activity, and to eliminate the problem that has already appeared, revision arthroplasty of the hip joint is used.

Lameness

Lameness is a common complication after hip arthroplasty. Such a pathology can develop as a result of some cases:

• Patients who have had a broken leg or femoral neck often experience shortening of one leg after hip replacement surgery, resulting in lameness when walking.
• Long-term immobilization, the state of rest of the lower limb can provoke atrophy of the leg muscles, which will cause lameness.

Surgical intervention will help to get rid of the complication, during which bone tissue is built up to equalize the length of the legs. Patients and physicians resort to this option extremely rarely. As a rule, the problem is solved by using special insoles, linings in shoes or wearing special shoes with different heights of soles and heels, which are sewn to order.

Groin pain

A rare complication after hip arthroplasty is pain in the groin area from the surgical intervention. Caused pain can be a negative reaction of the body to the prosthesis, an allergy to the material. Pain often occurs when the implant is placed in the anterior acetabulum. To get rid of the pain syndrome and get used to the new joint will help the implementation of special physical exercises. If this does not bring the desired result, revision arthroplasty will have to be performed.

Swelling of the legs

After surgery, as a result of keeping the leg at rest for a long time, such a complication as swelling of the lower extremities is often observed. The blood flow, metabolic processes are disturbed, which leads to swelling and pain. Taking diuretics, keeping your legs elevated, using compresses that relieve swelling, as well as regular simple exercises will help get rid of such a problem.

Therapeutic exercises for recovery after arthroplasty

To get rid of complications after hip arthroplasty, and to make the rehabilitation process as quick and painless as possible, it is necessary to regularly perform physical exercises prescribed by the doctor. Thanks to simple actions, the motor activity of the new artificial joint develops, the patient returns to the ability to move with his legs without the use of crutches.

A set of exercises for recovery after hip arthroplasty is selected individually. It takes into account the following factors:

• patient's age;
• activity of the lower limb where the joint was replaced;
• the general health of the patient;
• psychoemotional state of the patient.

When performing physical exercises and while walking, it is important to remember that patients after hip arthroplasty are strictly prohibited from:

• crossing legs;
• flexion of the lower extremities in the hip joint by more than ninety degrees;
• twisting the leg to the side.

To make rehabilitation more effective, perform a set of exercises after hip replacement surgery:

1. Take a supine position (a firmer surface is ideal - an elastic mattress or floor), alternately perform a series of simple exercises:

• Bending the legs at the knee joint without lifting the foot from the surface.
• Abduction of the lower extremities to the side (alternately with a leg with an artificial and a natural joint).
• Bike. Raise your legs slightly up and perform movements that simulate riding a two-wheeled pedal vehicle.
• Alternate straightening and return to the bent position of the legs bent at the knees.

1. Change position by turning onto your stomach. In this position, do the following exercises:

• Flexion and extension of the knee joint.
• Raising the leg up.

1. Lying on your side, lift the straight lower limb up, and then take it to the side. Repeat the same exercise on the other side.
2. In a standing position, swing your legs forward, backward and abduct the lower limb to the side.
3. When performing this complex, do not make sudden movements so that the cup of the joint does not pop out, loosen, causing all sorts of complications and pain.

Rehabilitation centers and cost

For rehabilitation and getting rid of complications after arthroplasty, people often choose clinics abroad, preferring sanatoriums or clinics, for example, in Germany, Israel. But on the territory of Russia there are also medical centers where it is possible to undergo recovery after surgery, to cure the pathologies that have arisen after it. There are such clinics in major cities of the country, for example, Moscow, Voronezh, St. Petersburg, where qualified doctors work who can assist in rehabilitation.

The cost of rehabilitation measures after hip arthroplasty in different sanatoriums may differ depending on many factors:

• Hospital locations. In sanatoriums located in picturesque corners, the price per day will be much higher than in clinics located on the outskirts of the city.
• Services provided in the clinic. The larger the list of procedures, the higher the cost. Particularly relevant are massage, exercise therapy, classes on special simulators (for example, an exercise bike).
• The comfort of the wards or rooms directly affects the price of living in rehabilitation centers.

Sanatoriums, clinics and the cost of rehabilitation after hip arthroplasty in Moscow and St. Petersburg:

Video about rehabilitation methods

A course of rehabilitation in a clinic or sanatorium will help to cope with complications after hip arthroplasty. Medical institutions with experienced and polite staff, the latest equipment and the use of modern recovery methods are available not only in newfangled foreign health resorts, but also in Russian hospitals. Rehabilitation measures are aimed at reducing pain, improving overall health, restoring joint performance, and generating strength so that the implant can withstand certain loads.

For recovery after hip arthroplasty, methods are used, the effectiveness of which has been proven by many patients:

• Specialized therapeutic massage aimed at post-operative recovery, relieving pain that has arisen after surgery.
• Electrotherapy - removes pain and promotes rapid recovery.
• Laser therapy is a procedure that has a beneficial effect on the postoperative suture.
• Magnetotherapy - promotes tissue regeneration in the area of ​​surgical intervention.
• The adoption of thermal waters, which contributes to the rapid recovery of the joints, improves their mobility and reduces pain.
• Therapeutic gymnastics, exercise, which is carried out to improve the motor activity of the leg, depending on the physical, psychological and emotional state of the patient, and is prescribed after a thorough examination.

To obtain the maximum result, it is necessary to use all methods in combination. Watch the video to learn more about the methods of dealing with the consequences after hip arthroplasty:

​Modern production methods allow the production of high-quality endoprostheses with a long service life. With a careful attitude to their health, they will serve the patient for decades.

An important point is the refusal to cooperate with the doctors of the patient himself. In young patients, dislocation of the endoprosthesis occurs no more than 1.2%, while in older people the percentage is higher - 7.5.

Also absolute contraindications include the inability to move independently and polyallergy. Among the relative contraindications are cancer, liver failure, osteopathy (hormonal), obesity (III degree).​

• Deforming coxarthrosis III degree;
• An important part of it is the friction unit. It consists of two parts - an insert (articular cavity) and a head of an endoprosthesis on a leg, which is fixed in the femur. The durability of the prosthesis depends on the material from which the friction unit is made.​
• The hip joints are the largest and most loaded in our body. They experience constant stress, and therefore are at risk. A sign of beginning problems is pain in the hip joints. It can occur for various reasons (dislocation, fall, illness).
• It will be easier for the patient after the operation if he can, sitting in a chair, put his foot on a small bench;
• It is very important that the patient has a normal weight before the operation. This can significantly facilitate the postoperative period, reduce the load on the joint, and minimize complications. If physical activity is not possible due to pain in the hip joint, then a diet aimed at reducing weight to normal levels is indicated.

​Hip replacement, the price of which depends on the material of the prostheses, is performed under general or spinal anesthesia.​

Weakening of the joint, which may be accompanied by pain in it. Elimination of this complication is only surgical.

• ​Hip replacement (endoprosthetics) is an operation that results in the complete replacement of diseased cartilage and bones with artificial prostheses, consisting of a concave bowl and a spherical head. The main goal of this surgical intervention is to reduce pain caused by various diseases of the joint.​
• Patients are not recommended to bend the leg at an angle of more than 90°, turn it inward after implant placement. Dislocation of the artificial head of the joint can also occur with a fall. The symptoms are similar to a dislocation of a healthy joint. This is a sharp pain, swelling, forced position of the operated leg and its shortening. If the patient does not see a doctor after a dislocation, the temperature may rise due to the onset of inflammation.
• The patient is admitted to the hospital two days before the scheduled date of the operation. At this time, all the necessary procedures are carried out with the patient, if necessary, maintenance therapy is prescribed or adjusted. Operation progress:
• Post-traumatic coxarthrosis (serious damage to the acetabulum);
• Hip replacement is a complex operation (although its duration is short). Therefore, the initial examination, the selection of the optimal endoprosthesis and postoperative rehabilitation are very important (the use of NSAIDs is mandatory to prevent severe pain).​
• The main reason when joint replacement is indicated is coxarthrosis.

You can make for yourself a list of items that should always be within the reach of the patient: mobile phone, glasses, book, telephone directory, necessary medicines, water, TV remote control;

​Some patients feel more comfortable knowing they have the perfect blood for a transfusion. And sometimes the surgeon may insist on this. To do this, a reserve of one's own blood is created in advance. If this is not possible for some reason, then a donor can be found in advance from among close friends and relatives. The blood is examined for all kinds of infections, and then frozen. In this form, blood can be safely stored for about a month.​

• Complications after arthroplasty are possible, but they occur much less frequently than after other methods of treatment. At the same time, motor activity begins to recover the very next day after the operation, and after the end of the rehabilitation period, the patient can walk independently, even without the help of crutches.​
• But the main danger of this method is the high probability that the bones will not grow together.
• Hip replacement can lead to thrombosis. With a decrease in movement on the operated leg, stagnation of blood in the veins may develop. To prevent this, the patient is not allowed to lie down for a long time and anticoagulants are prescribed.
• When is arthroplasty performed?
• ​Hip replacement significantly improves the quality of life of the patient, however, an artificial articular head is not able to replace the real one.​

Preparation for arthroplasty consists of spinal anesthesia, cutting the skin over the operated joint, cutting soft tissues and the joint bag. After that, the surgeon gets access to the destroyed joint.

fb.ru

Fracture of the femoral neck in the elderly, arthroplasty at the FCS clinic

Tumor in the neck of the femur or its head. Surgical treatment The decision to operate is made by the doctor and the patient. It is important to explain to the patient that refusing the operation will result in disability and, in some cases, complete immobility. The patient should be aware that complications after hip arthroplasty are possible: Abrasion of the articular head leads to severe pain that is not relieved even by non-steroidal anti-inflammatory drugs. If energetic and temperamental animals live in the house, then it is better to temporarily remove them from the house to avoid the patient falling. You need to straighten your teeth. A tooth affected by caries is a potential source of infection that can lead to postoperative complications. The doctor prescribes the first simple exercises the next day after arthroplasty, subsequently the set of exercises expands and their intensity increases. Within 10 days, patients are in the hospital, under constant supervision, after which they can be discharged for further rehabilitation at home.​ Endoprosthetics of the hip joint To date, surgical treatment is the most rational way to return the patient to working capacity. There are two surgical options: Ossification is the impregnation of the tissues surrounding the joint with calcium salts. This factor can lead to limited joint mobility.​ Hip replacement is performed for the following conditions: To avoid dislocation, the patient must be very careful not to make sudden movements, monitor the appearance of alarming symptoms. A systematic visit to the doctor is necessary. This is followed by the stage of dislocation (twisting) of the femoral head from the acetabulum. A template is installed and sawdust of the proximal femur. After that, the sawn off head of the joint is removed, the acetabulum is processed with cutters (prepared for the installation of the acetabular component of the endoprosthesis). The acetabular component is fixed either with cement or screws. Then the liner is installed.​ In case of a fracture of the femoral neck and aseptic necrosis of the head (III-IV degree), surgery is also necessary. the risk of blood clots in damaged vessels; Rehabilitation An artificial mechanism that is installed in the human body for one reason or another is called an endoprosthesis. Endoprosthetics is a complex operation to remove part of the destroyed bone and replace it with an implant. The service life of a modern endoprosthesis is long (15–20 years on average). At the end of this period, the artificial joint is replaced with a new one (an operation for re-endoprosthetics is performed).

Special attention deserves the preparation of a bathroom and toilet for a person after a joint replacement operation. Be sure to provide the bathroom and toilet with handrails. It would be good to purchase a chair in advance on which the patient will take a shower. He must be stable. In addition, care must be taken to ensure that this chair does not slip. Soap, shampoo and everything else that you may need in the bathroom should be able to reach while sitting on a chair. The toilet will have to be raised so that the knees of the seated person are higher than the hip joint.

traumapunkt.ru

The surgeon must be informed of all medications taken. This also applies to medicinal herbs.

Indications for hip replacement

Call us:

Arthrosis of the hip joint

1. Osteosynthesis, or reposition.

Hip fracture

Prosthesis displacement. May occur during certain movements. To avoid this complication, patients should not cross their legs or bend them at the hip joints by more than 80 degrees.

Arthritis

Arthrosis.

The dislocation is reduced under anesthesia (intravenous or spinal). After that, the limb is fixed. If it is not possible to correct the dislocation, they resort to surgery.

Preparation for prosthetics

A hip endoprosthesis is placed in the femur. This opens the medullary canal. Then it is prepared for implantation using osteoprofilers. The femoral part of the endoprosthesis is inserted into the prepared hole. The head is installed in the acetabulum.

After clarification of the anamnesis and examination, chronic diseases are identified. Absolute contraindications for arthroplasty are systemic diseases:​

Large blood loss during and after surgery;

Two types of anesthesia are used during hip replacement surgery.

​Some medications will need to be stopped in advance.​​Some injuries and their consequences, as well as some diseases, lead to the fact that the only chance for a full life is a hip replacement.

Fragments of the femur in this method are compared in such a way as to ensure their maximum contact, and then fixed with metal screws. Such operations can rarely be recommended for older people, primarily because of the low probability of bone fusion.​

How to prepare your home for the postoperative period

Change in the length of the operated leg. This complication occurs as a result of relaxation of the muscles surrounding the joint. This problem is solved by performing special physical exercises.

• Fracture of the femoral neck.
• The service life of modern endoprostheses is more than 20 years. Many patients live without problems up to 30 years after the operation and do not present any complaints. However, sooner or later, re-endoprosthetics will be required - this is the replacement of a worn-out implant with a new one.
• The surgeon checks how the limb will function (moves it in different directions). If everything is normal, the soft tissues are sutured first, then the sutures are applied to the skin. A drainage tube is installed to drain possible blood. The duration of the operation is no more than two hours, depending on the degree of destruction of the hip bone.​
• Cardiovascular and bronchopulmonary (in the acute stage);
• Infection at the site of the prosthesis (the patient has a fever, pain is felt in the area of ​​the operated joint, the skin is hyperemic);
• The endoprosthesis can be made of titanium and steel alloys (stainless), ceramics and high-strength plastics. The peculiarity of these materials is strength and, at the same time, ease of processing. It is quite difficult to make a high-quality endoprosthesis, so there is control at every stage of production. All products have their own quality certificate. ​
• The drug in the gaseous state enters the lungs through a special mask. After the patient is asleep, a ventilator tube is inserted into his airway. Using various sensors, the anesthesiologist monitors the patient's condition throughout the operation.​
• ​As part of the overall health of the body before the hip replacement surgery, it is very desirable to stop smoking. This measure will also help prevent complications.

Hip replacement is indicated for certain types of injuries and diseases of the bones and joints.

Anesthesia during surgery

2. Endoprosthetics.​

General

Hip replacement surgery

Regional

Polyarthritis.

The operation is more complicated than primary arthroplasty, as it requires the removal of the old prosthesis, cleaning the acetabulum and the canal in the hip bone.

The postoperative period is long. The patient can begin to move already in the first day. On the second day, light gymnastics in a sitting position is allowed. You can walk with the help of a walker already on the third day. The stitches are removed after about two weeks. All this time, the patient receives full treatment with antibiotics and painkillers. Additionally, symptomatic treatment may be prescribed. Mental abnormalities and problems with the nervous system;

risk of developing pneumonia;

​The artificial joint can be fixed with or without cement based on acrylic resin and chromium or cobalt alloy.​

bolit-sustav.ru

Hip replacement or endoprosthesis: preparation for surgery

There are two types of regional anesthesia: spinal, epidural, or a combination of both. During the operation, the patient is immersed in sleep, but he wakes up immediately after it is over, without feeling any pain.

First of all, it is necessary that someone is constantly near the patient after the operation. In addition, you will have to adapt your home in such a way as to make life easier for the patient:

This disease is the result of damage to the cartilage tissue of the joint. Most often, cartilage wears out with age, so this condition is common in older people. Less commonly, arthrosis develops as a result of injury.

What is endoprosthetics

​In this case, the damaged fragments of the bone and joint are replaced with implants, providing full restoration of mobility. The method is highly effective and allows you to return to physical activity as quickly as possible.​

Types and materials of endoprostheses

Basically, arthroplasty is carried out according to the general scheme:

Violation of the process of blood supply to the hip joint.

The new acetabular insert will be larger, as will the implant head. ​

When lying on the bed, it is important to keep a tight roller between your legs. It helps to maintain the correct position of the operated leg. After the stitches are removed, the patient is discharged. For the next 2 months after the operation, it is recommended to limit the load on the leg. You need to walk, but with the use of crutches or a walker.

1. Prolonged infection in the area of ​​the damaged joint (3 months or more);
2. dislocation of the endoprosthesis (treatment period increases);

Hip prosthetics are divided into two types:

The type of anesthesia is discussed with the patient in advance. The anesthesiologist studies the medical history, talks with the patient before the operation, explains to him the principle of action and possible side effects from different types of anesthesia, after which, having all the necessary information, the patient decides on the method of anesthesia during the joint replacement surgery.​

All items needed in everyday life should be placed at arm's length;

In old age, such a fracture may no longer heal. In this case, joint replacement is not only the ability to walk, but in principle to live.​

How is the treatment

​Surgery to replace damaged areas with endoprostheses is the most reliable method of treating a hip fracture, especially in the elderly, and in some cases, such as significant displacement of fragments or a complex fracture, it is the only option to restore mobility.​

• An incision is made on the lateral or frontal surface of the thigh.
• Necrosis of the femoral head, which may be caused by taking certain medications or performing certain surgical interventions (for example, kidney transplants).
• Re-endoprosthetics may also be required in case of accidental injuries of the previously operated hip. Therefore, it is very important to be careful so that the implant lasts as long as possible. Preparation for reendoprosthetics is no different from primary prosthetics. It is shorter in time, since the attending physician already has a complete history.
• Hip replacement can be complicated by dislocation. There are several reasons - the structural features of the artificial articular head, the human factor (the patient himself is to blame), the surgeon's mistake due to lack of experience (in particular, the operation is performed from behind). At risk are:
• acute diseases of the vessels of the extremities;
• Loosening (legs or heads), the result is a paraprosthetic fracture.

head replacement;

Indications

12 hours before the operation, nothing should be eaten, and 7 hours before the operation, nothing should be drunk. It will be possible to eat for the first time after the operation in the evening of the same day.​

• If the house has more than one floor, then you need to make sure that everything necessary for a person after the operation is located on the first floor;
• Inflammation in the joint can lead to irreversible consequences. Sometimes a total joint replacement is the only possible way to restore the patient's mobility.​
• Endoprosthesis can be:
• Cartilage tissue or affected bone is removed.

However, hip replacement is not performed immediately after diagnosis. Surgical intervention is performed only when the pain in the joints becomes permanent, contributes to the deterioration of the simplest functions (walking, climbing stairs, etc.) and is not relieved with the help of the strongest painkillers.​

Contraindications

Joint surgeries help desperate patients who experience constant severe pain to be able to move independently, albeit with a crutch or cane.

• patients with hip fracture and dysplasia; ​
• A focus of infection in the body (including caries, tonsillitis, sinusitis);
• The patient may develop a fever immediately after the operation. This is the body's response to surgery. Therefore, taking antibiotics for 10 days after surgery is mandatory.
• Replacement of cartilage tissue (with intact bone).
• Sometimes the patient may experience nausea from anesthesia. It is not necessary to endure it, it is better to seek help, and the doctor will prescribe a drug to relieve nausea.
• It is better to free up space as much as possible from excess furniture and other items in order to provide the patient on crutches with free movement around the room and between them;
• Prosthesis of the hip joint in most cases allows the patient to have an absolutely normal, fulfilling life.

Unipolar, when only the neck and head of the femur are replaced;

Operation

The cavity sleeve is implanted.

1. Are there any risks in this operation?
2. Preparation takes a little time. It is necessary to undergo a complete examination, according to the results of which the doctor will make a diagnosis and recommend treatment. The conservative method often does not justify itself, since the destroyed joint cannot be restored by medical or other non-surgical methods, the pain intensifies over time.
3. who have undergone previous surgeries;
4. young age (when the skeleton is in the growth stage);
5. Endoprosthesis replacement has become popular due to frequent injuries of the hip joints. The installation of implants helps patients to lead an active lifestyle, take care of themselves, and work. Hip replacement is indicated for the following conditions:​
6. The second option is a priority for young active people. It leaves the bone intact, thanks to which all the motor functions of the joint are preserved as much as possible. This operation is much easier than with the installation of a full-fledged implant; in the postoperative period, the patient almost does not feel pain. There is also an endoprosthesis with a shortened leg. It allows you to save most of the patient's femur, while holding as firmly as a standard one.

Symptoms of dislocation of the endoprosthesis

It is very important to trust the surgeon and the anesthesiologist. With proper preparation and rehabilitation after surgery, complications do not threaten the patient. And a positive attitude and support from loved ones before surgery and in the postoperative period can work wonders.

• A good sturdy chair should be purchased in advance in which the patient sits so that the knees are below the hip joint, which will allow him to stand up easily;
• In order to avoid complications, joint replacement surgery must be carefully prepared. Before the operation, it is necessary to undergo a complete examination of the body. All chronic diseases are taken into account. A course of treatment is prescribed so that by the time of surgery the patient is as healthy as possible. The condition is necessarily corrected in case of arterial hypertension, diabetes mellitus, blood clotting disorders. Suitable anesthesia is selected.
• Bipolar or total, if the acetabulum of the pelvic bone is also replaced.

The hip joint is replaced with an artificial prosthesis that is attached to the hip bone.

As with any other surgical intervention, arthroplasty may have complications:

The doctor must explain to the patient that joint prosthetics will help get rid of pain, will make it possible to live a full life.

Patients with joint hypermobility.

Absence of the medullary canal of the hip bone (if a hip replacement surgery is performed).

Re-endoprosthetics

One- and two-sided deforming arthrosis (II-III degree);

For each patient, the endoprosthesis is selected individually.

The house should be inspected as if a small child lived there, and wires, sharp corners, slippery surfaces, thresholds in doorways should be removed, and good lighting should be made throughout the house, including corridors;

Benefits of arthroplasty

To facilitate the postoperative period, the patient is prescribed special exercises. It is important to have strong arms and developed torso muscles. It will be difficult to learn to walk with crutches after surgery. It is better to master this skill in advance.

​Implants are fixed using the cement-free or cement-based method. The first method is more suitable for young patients, since in this case prostheses with a porous structure are used, which are connected to the bones without additional fixators.

A suture is applied at the incision site.

Penetration of infection into the surgical wound or into the place where an artificial prosthesis is installed. This can manifest as redness, swelling, and pain at the surgical site. To prevent such complications, antibiotics are prescribed.

The human body interprets any foreign element as a threat. As a result, the tissues around the implant are saturated with cells that are designed to fight harmful organisms and infection. This may be the main reason for rejection.

Despite the fact that there is such a possibility, rejection of the endoprosthesis is extremely rare, because:

• before installing an artificial element, individual sensitivity to the material is checked;
• an additional check for a possible allergic reaction;
• design of modern prostheses adapts as much as possible to the individual characteristics of the patient, and the degree of manufacturing accuracy allows us to talk about identity with the patient's joint.

To provoke the development of instability of the new joint can be an infectious disease that a person encountered after surgery.

You need to understand that the initial problem that led to the need for a joint replacement may again make itself felt. Increasingly, in practice, there are oncological diseases that lead to the destruction of the joint.

After its replacement, the disease may not stop or return. This provokes the development of unpleasant orthopedic consequences.

Hip arthroplasty is a surgical operation during which a joint destroyed by a primary disease or injury is replaced with an artificial prosthesis.

In modern traumatology and orthopedics, total hip arthroplasty is mainly performed, i.e. installation of all components of the endoprosthesis and their complete replacement of all anatomical elements of the modified joint.

Video of hip arthroplasty surgery

Currently, there are a huge number of varieties of endoprostheses, which allows you to choose the most optimal configuration option for each specific case.

Any artificial model of the joint is a high-quality imitation of the natural hip bone and cartilage connection. According to the method of fixing the endoprosthesis, the following options are mainly used:

• cement-retained prosthesis (with this option, special bone cement is used during the operation, which allows you to securely fix the endoprosthesis);
• prosthesis with cementless fixation (with this option, the surface of the prosthesis is covered with a special material, which allows the bone tissue to grow inside the implant, so the bone and the prosthesis become one after a certain time;
• combined option (for certain indications)

Symptoms of Hip Prosthesis Instability

Even during the consultation period with the attending physician, the patient should be explained the possible side effects and complications after the operation. The surgeon himself must foresee such negative consequences on the basis of diagnostic data during the examination of the patient.

Incorrect selection of an individual prosthesis can lead to the fact that it will fail after five years after installation. Re-operation of arthroplasty can be avoided if all precautions are taken and actions that can damage the stability of the implant are not performed.

Methods for the treatment of joint implant instability

Loosening of a hip replacement usually occurs within one to two years after surgery. Timely diagnosis and treatment will help to avoid serious consequences.

In this case, it will be possible to quickly normalize and stabilize the process of bone tissue restoration. It will also have a positive effect on the process of integration of the prosthesis into the human body.

Temporary walking with crutches may be prescribed as a preventive measure. In parallel, a course of taking appropriate medications is prescribed. In some cases, the patient will be recommended certain physical exercises for the lower extremities.

What are the common complications after hip replacement surgery?

Prosthesis displacement

As a result of this phenomenon, the implanted implant not only loses its fixation and loosens, but also leads to a gradual or sharp change in the length of the legs. In this case, an immediate consultation with a doctor and a second operation on the limb is required. The main reasons include the following:

• improper placement of the implant;
• insufficient contact between the surfaces of the joint and the prosthesis;
• heavy loads on the implant;
• weak connection of the components of the product.

Osteolysis

Partial or complete destruction of the bone, which occurs as a result of the interaction of the components of the prosthesis with living tissue, can lead to the formation of this process.

Fracture of a medical device

Diagnosis of prosthesis fractures, which occur periodically, suggests the following reasons for such consequences. These include:

• incorrect selection of an individual implant;
• excessive or premature high physical activity of the patient;
• overweight patient.

To prevent the onset of such consequences, it is required to strictly follow the recommendations given by the doctor and not engage in excessive motor activity.

Special cases include loosening and damage to individual components of the prosthesis. In a fairly short time, the structure of the polyethylene liner or the femoral stem may collapse.

Dislocation or fracture of the endoprosthesis also occurs quite often. Therefore, it is mandatory to follow the recommendations of specialists, as well as to carry out diagnostic and preventive measures.

This is guaranteed to help prevent the occurrence of negative consequences of the operation.

Formation of blood clots

Such clots form in the vessels of the lower extremities. This complication does not require repeated surgical intervention. It is enough to take a therapeutic course prescribed by a doctor. It may include various physical exercises for the legs or taking medications.

inflammation

To prevent the development of infectious processes, experts recommend taking antibiotics in the first two years after the installation of the prosthesis. The prescription of drugs in each case is considered individually, based on the general condition of the patient's body.

megan92 2 weeks ago

Tell me, who is struggling with pain in the joints? My knees hurt terribly ((I drink painkillers, but I understand that I am struggling with the consequence, and not with the cause ... Nifiga does not help!

Daria 2 weeks ago

I struggled with my sore joints for several years until I read this article by some Chinese doctor. And for a long time I forgot about the "incurable" joints. Such are the things

megan92 13 days ago

Daria 12 days ago

megan92, so I wrote in my first comment) Well, I'll duplicate it, it's not difficult for me, catch - link to professor's article.

Sonya 10 days ago

Isn't this a divorce? Why the Internet sell ah?

Yulek26 10 days ago

Sonya, what country do you live in? .. They sell on the Internet, because shops and pharmacies set their margins brutal. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. Yes, and now everything is sold on the Internet - from clothes to TVs, furniture and cars.

Editorial response 10 days ago

Sonya, hello. This drug for the treatment of joints is really not sold through the pharmacy network in order to avoid inflated prices. Currently, you can only order Official website. Be healthy!

Sonya 10 days ago

Sorry, I didn't notice at first the information about the cash on delivery. Then, it's OK! Everything is in order - exactly, if payment upon receipt. Thank you very much!!))

Margo 8 days ago

Has anyone tried traditional methods of treating joints? Grandmother does not trust pills, the poor woman has been suffering from pain for many years ...

Andrew a week ago

Medicine develops with the times, and its discoveries allowed a person to restore the activity of the lower extremities by replacing a damaged joint with a prosthesis. This operation can relieve pain and discomfort, restore normal leg mobility and help prevent disability. But it happens that there are various complications that require hip arthroplasty. Anomalies may occur due to the fact that the prosthesis did not take root, the doctor made a mistake, an infection was introduced, or restoration procedures were performed incorrectly.

Pain syndromes

When a joint is replaced, pain will inevitably occur, because this is a standard postoperative syndrome. But only if the patient has unbearable pain and it lasts more than two weeks after surgery, then this is already abnormal! In such a situation, you should contact the hospital to your doctor.

Also, pain may be accompanied by concomitant symptoms. This is an increase in temperature, the occurrence of bleeding, suppuration and swelling. These signs also indicate the development of pathological processes in the body.

There are a number of complications that can develop after arthroplasty and cause similar symptoms. These include:

• implant rejection;
• penetration into the wound of the infection when the operation was performed;
• the endoprosthesis has shifted;
• periprosthetic fracture;
• dislocations or subluxations of the prosthesis;
• thrombosis of veins that are deep;
• change in leg length;
• neuropathy;
• blood loss.

Pain in the groin

This is a rare complication. Pain in the groin occurs from the surgical intervention. This symptom is caused by a negative reaction of the body to the endoprosthesis, an allergy to the material. Often, pain occurs if the artificial joint is located near the anterior acetabulum.

Specific physical exercises relieve pain and promote addiction to the implant. When this method is ineffective, revision arthroplasty is performed.

In the lower back

Pain occurs in the lumbar region if the patient has osteochondrosis. More specifically, the lower back begins to hurt with an exacerbation of this disease. The exacerbation provokes the alignment of the limbs, which is carried out after the operation.

Giving to the knee

There may be pain in the limbs that radiates to the knee. It is especially felt when turning with your feet or strong loads on them. When the leg hurts after arthroplasty, the cause is easy to determine. Soreness is a clear sign of instability of the femoral component of the prosthesis.

Instability develops due to micro-movements between the prosthesis and the bone. This causes the prosthesis to loosen. Various parts of the hip may loosen, such as the stalk (femur component) or calyx (acetabular component).

Lameness and swelling

Lameness often occurs after the arthroplasty procedure. Provoke its development such cases:

• Patients who have had a fracture of the neck of the femur or leg are quite susceptible to such a complication as shortening of one leg. This anomaly is a prerequisite for lameness.
• Long stay without movement causes atrophy of the muscles of the limb and is the cause of lameness.

In the postoperative period, the lower limbs remain at rest for a long time, and such a complication as swelling of the legs is observed. Namely, in the limbs, blood circulation and metabolism are disturbed, which is a provocateur of swelling and pain. Get rid of such a symptom by taking diuretics, keeping the legs in a slightly elevated state. Also using compresses that relieve swelling, and performing simple exercises.

Unequal leg length

Symmetry or leg length is broken after hip replacement - this is a rather rare occurrence. The cause of this anomaly may be an injury to the femoral neck. If the technique of bone restoration is violated, there is a possibility of a change in the length of the affected leg.

This complication can be overcome with the help of an operation during which bone tissue is increased in order to even out the length of the legs. Patients and doctors rarely resort to this option. Most often, the problem is solved by using specific insoles, linings in shoes or wearing unusual shoes with different heights of soles and heels. But these shoes are made to order.

neuropathy

Neuropathic syndrome is a lesion of the peroneal nerve, which is part of the structure of the greater sciatic nerve. This pathology happens, it provokes the lengthening of the leg after the prosthetic procedure, the pressure of the hematoma that has arisen on the nerve root. Rarely is the cause of intraoperative damage due to inaccurate actions of the surgeon. Restore the nerve by performing etiological therapy, optimal surgical technique or physical rehabilitation.

Endoprosthesis infection

A purulent formation in the place where the joint was replaced is considered a very dangerous complication. It is usually difficult to treat. Therapy requires large material costs. And usually get rid of this pathology by repeated surgical intervention.

Symptoms of such a pathology can manifest themselves in the following way:

• the place where the surgical scar is located turns red and swells;
• the seam slowly overgrows, and its edges diverge and form a fistula;
• serous or purulent fluid is released from the wound;
• postoperative wound smells unpleasant;
• the patient complains of pain in the leg, which can be very powerful, so much so that they can provoke pain shock and immobilization;
• the prosthesis itself becomes unstable.

This infection progresses very quickly. Untimely or inadequate therapy provokes the retraining of pathology into chronic osteomyelitis. Treatment takes a long time. The implant can be replaced only when the patient has completely overcome the infection.

In the preventive measures of this complication, immediately after the replacement of the implant, the patient is prescribed a course of antibiotic therapy. They are drunk within two or three days.

Temperature rise

The performed arthroplasty operation often provokes the occurrence of hyperthermia, or an increase in the overall thermal state of the body. Also, patients often complain of increased local temperature in the area of ​​implantation. There are situations when the temperature rises due to the stress of the operation, and there are situations when it is caused by inflammation or infection.

Usually, antipyretics are taken to reduce it. When some pathology provokes it, it is not enough to eliminate the temperature, you need to overcome the cause.

Dislocation and subluxation of the implant

This kurtosis may occur in the first year after the prosthesis has been carried out. This condition is leading in its prevalence. The pathology is characterized by a displacement of the femoral element in relation to the acetabular element. Because of this, separation of the cup of the prosthesis and the head is observed.

The provocative factor is abnormal loads, injuries, errors in the chosen model and installation of the endoprosthesis, and the use of a posterior surgical approach. The dislocation is usually reduced without surgery or by open reduction. If you turn to a specialist in a timely manner, then the head of the implant is set in a closed way, the patient at this moment is under anesthesia. In advanced situations, the doctor prescribes a second operation to reinstall the prosthesis.

Periprosthetic fracture

The risk group includes people with a fractured femoral neck, overweight, dysplasia, neuromuscular abnormalities, increased joint mobility, and Ehlers syndrome. And also in older people who are older than sixty years, the likelihood of a periprosthetic fracture is high. Such an anomaly, in which the integrity of the femur is violated near the fixation zone of the leg with a stable or unstable prosthesis, occurs intraoperatively. It can occur absolutely at any time after the surgical session (after a couple of days, months or years).

A fracture is often caused by low bone density. But it can also be provoked by incompetent development of the bone canal before installing an artificial articulation. Or the wrong fixing method may be the cause. Treatment depends on the type and severity of the injury. Usually one of the methods of osteosynthesis is used. The leg, if necessary, is replaced with one that is more suitable for the configuration.

Deep vein thrombosis

Reduced motor activity in the period after surgery provokes the occurrence of blood stasis, the result of which is thrombosis. And then it all depends on how big the clot is and where the blood flow will take it. Because of this, the following consequences can occur: pulmonary thromboembolism, gangrene of the legs, heart attack and others.

This pathology should be prevented as early as possible. Already on the second day after implantation of the joint, anticoagulants are prescribed.

blood loss

During surgery to replace the pelvic joint or after a certain time after this procedure, there is a chance of bleeding. The cause can be both a doctor's mistake and any inaccurate movement or abuse of blood-thinning drugs. In the postoperative moment, anticoagulants are prescribed to prevent thrombosis.

Sometimes it is this precaution that can "go sideways." It is able to turn the preventive measures of one complication into another complication. The patient needs a blood transfusion to replenish the blood supply.

Displacement of the endoprosthesis

Displacement of the pelvic joint implant may be due to impaired mobility and postoperative recommendations. It is strictly forbidden to cross the limbs or raise them high. Displacement causes powerful pain and discomfort.

Implant rejection

The body rejects the installed prosthesis very rarely, because before the operation, the sensitivity of the cells of the body to the material of the prosthesis is always tested. In situations in which the material did not fit, a replacement is made and it is retested. The procedure is carried out until a suitable material is selected that will match the tissues.

prospinu.com

What is a hip arthroplasty

A complex surgical operation that requires replacing worn or destroyed parts of the largest joint of bones in the body in the form of a hip joint (HJ) with artificial parts is arthroplasty. The "old" HJ is replaced by an endoprosthesis. It is called so because it is installed and located inside the body (“endo-”). The product is subject to the requirements of strength, reliability of fixation of components and biocompatibility with tissues and structures of the body.

The artificial “joint” bears more load due to the absence of friction-reducing cartilage and synovial fluid. For this reason, prostheses are made from high quality metal alloys. They are the most durable and last up to 20 years. Polymers with ceramics are also used. Several materials are often combined in one endoprosthesis, for example, plastic with metal. In general, the formation of an artificial hip joint is provided by:

• prosthesis cup, replacing the acetabulum of the joint;
• friction-reducing polyethylene liner;
• head, providing soft sliding during movements;
• the pedicle, which takes the main loads and replaces the upper third of the bone and the femoral neck.

Who needs

Indications for arthroplasty are serious damage to the structure and functional disorders of the hip joint, which lead to pain during walking or any other physical activity. This may be due to trauma or previous bone diseases. The operation is also necessary for stiffness of the hip joint, a significant decrease in its volume. Among the specific indications for arthroplasty are:

• malignant tumors of the neck or head of the femur;
• coxarthrosis of 2-3 degrees;
• hip fracture;
• hip dysplasia;
• post-traumatic arthrosis;
• aseptic necrosis;
• osteoporosis;
• osteoarthritis;
• Perthes disease;
• rheumatoid arthritis;
• the formation of a false hip joint, more often in the elderly.

Contraindications

Not all people who need arthroplasty can have hip surgery. Contraindications to it are divided into absolute, when surgical intervention is prohibited, and relative, i.e. it is possible, but with caution and under certain conditions. The latter include:

• oncological diseases;
• hormonal osteopathy;
• 3 degree of obesity;
• liver failure;
• chronic somatic pathology.

Absolute contraindications include more diseases and pathologies. Their list includes:

• foci of chronic infection;
• absence of a medullary canal in the thigh;
• thromboembolism and thrombophlebitis;
• paresis or paralysis of the leg;
• immaturity of the skeleton;
• chronic cardiovascular insufficiency, arrhythmia, heart disease;
• violation of cerebral circulation;
• impossibility of independent movement;
• bronchopulmonary diseases with respiratory failure, such as emphysema, asthma, pneumosclerosis, bronchiectasis;
• recent sepsis;
• multiple allergies;
• inflammation of the hip joint associated with damage to the muscles, bones or skin;
• severe osteoporosis and low bone strength.

Types of hip endoprostheses

In addition to classification by materials, hip endoprostheses are divided according to several other criteria. One of them is based on the components of the prosthesis. He might be:

1. Unipolar. In this case, the prosthesis consists only of a head with a stem. They replace the corresponding parts of the hip joint. "Native" remains only the acetabulum. Today, such a prosthesis is rarely used. The reason is that the risk of destruction of the acetabulum is high.
2. Bipolar, or total. This type of prosthesis replaces all parts of the hip joint - the neck, head, acetabulum. It is better fixed and maximally adapted to the body. This increases the success of the operation. The total prosthesis is suitable for older people and young people with their high activity.

Endoprosthesis service life

The number of years that an endoprosthesis can last depends on the materials used in the manufacture. The strongest are metal. They serve up to 20 years, but at the same time they differ in less functional results in relation to the motor activity of the operated limb. Plastic and ceramic prostheses can boast of a shorter service life. They can serve only 15 years.

Types of endoprosthetics operations

Depending on the prostheses used, arthroplasty can be total or partial. In the first case, the head, neck and acetabulum of the articulation are replaced, in the second case only the first two parts are replaced. Another classification of the operation uses the method of fixation of the endoprosthesis as a criterion. Ceramic or metal must be firmly connected to the bones so that the hip joint can fully work. After choosing the endoprosthesis and its size, the doctor determines the type of fixation:

1. Cementless. Fixation of the implant in place of the hip joint is carried out due to its special design. The surface of the prosthesis has many small protrusions, holes and depressions. Over time, bone tissue grows through them, thus forming an integral system. This method increases the recovery time.
2. Cement. It consists in attaching the endoprosthesis to the bone due to a special biological glue called cement. It is being prepared during the operation. Fixation occurs due to the hardening of the cement. Recovery of the hip joint in this case is faster, but the risk of implant rejection is high.
3. Mixed or hybrid. It consists in a combination of both methods - cement and cementless. The leg is fixed with glue, and the cup is screwed into the acetabulum. It is considered the most optimal way to fix the prosthesis.

Preparing for the operation

The first event before the operation is a doctor's examination of the legs. Radiography, ultrasound and MRI of the operated area are used as diagnostic procedures. The patient is hospitalized two days before the scheduled operation for a number of procedures that will help eliminate the presence of contraindications. Held:

• blood coagulation analysis;
• OAM and UAC;
• determination of blood group and Rh factor;
• biochemical blood test;
• tests for syphilis, hepatitis, HIV;
• consultations of narrower specialists.

Further, the patient is provided with information about possible complications, they are offered to sign a consent to surgical intervention. At the same time, instruction is given on behavior during and after the operation. Only a light supper is allowed the night before. You can't eat or drink in the morning. Before the operation, the skin in the thigh area is shaved, and the legs are bandaged with elastic bandages or compression stockings are put on them.

Operation progress

After transporting the patient to the operating room, I give him anesthesia - full anesthesia with controlled breathing or spinal anesthesia, which is less harmful, therefore it is more often used. The hip replacement technique is as follows:

• after anesthesia, the doctor treats the surgical field with antiseptics;
• then he dissects the skin and muscle, making an incision of about 20 cm;
• then the intra-articular capsule is opened and the femoral head is removed into the wound;
• then comes its resection until the bone marrow canal is exposed;
• the bone is modeled taking into account the shape of the prosthesis, it is fixed using the chosen method;
• using a drill, it processes the acetabulum to remove cartilage from it;
• a cup of the prosthesis is installed in the resulting funnel;
• after installation, it remains only to compare the prosthetic surfaces and strengthen by suturing the incised wound;
• a drain is inserted into the wound and a bandage is applied.

Temperature after hip arthroplasty

Within 2-3 weeks after the operation, an increase in temperature may be observed. This is considered normal. In most cases, the body tolerates high temperatures well. Only in very bad condition can you take an antipyretic pill. It is only necessary to inform the doctor if the temperature rises after a period of several weeks, when it was normal.

Rehabilitation

The operation to replace the hip joint requires the start of rehabilitation in the first hours after its completion. Rehabilitation activities include physiotherapy exercises, breathing exercises and early activation in general. The leg should be in functional rest, but movement is simply necessary. You can not get up only on the first day. Changing the position of the body in bed, performing slight flexions in the knee joint may be allowed by the doctor. In the following days, the patient can begin to walk, but with crutches.

How long does it take

Rehabilitation within the walls of the clinic lasts about 2-3 weeks. At this time, the doctor controls the wound healing process. Postoperative sutures are removed approximately on the 9-12th day. Drainage is removed as the discharge decreases and completely stops. For about 3 months, the patient must use the means of support when walking. Full walking is possible after 4-6 months. Approximately how long does rehabilitation after hip arthroplasty last.

Life after hip replacement

If a person is somatically healthy and has no concomitant diseases, then he is able to restore the functionality of the leg almost completely. The patient can not only walk, but also play sports. You can not perform only exercises related to the power tension of the limbs. Complications after endoprosthetics are observed more often in the elderly or in case of non-compliance with the postoperative regimen.

Disability after arthroplasty

Not all cases of hip replacement lead to disability. If the patient is in pain and unable to do his job normally, then he can apply for it. Recognition of a person as a disabled person is carried out on the basis of a medical and social examination. To do this, you need to contact the clinic at the place of residence, go through all the necessary specialists.

The basis for disability is often not the endoprosthesis itself, but the diseases that required surgery. Specialists consider the severity of impaired motor functions. If, after surgery, reduced functionality remains in the hip joint, then the patient is given a 2-3 disability group for 1 year with the possibility of subsequent re-registration.

Operation cost

Almost all patients are interested in the question of how much a hip replacement costs. There are several programs for which this operation can be carried out:

• free of charge under the CHI policy (in this case, you may face a queue for 6-12 months in advance);
• for a fee in a private or public clinic;
• free of charge under the quota of high-tech medical care (circumstances are necessary here for the provision of benefits).

In addition to the cost of the operation itself, the cost of a hip joint prosthesis is also important. It depends on the reason that led to the need for endoprosthetics. With coxarthrosis, the cost of the prosthesis will be higher than with a fracture of the femoral neck. The approximate cost of hip replacement surgery and prosthesis is shown in the table:

sovets.net

How to organize your life to avoid complications after total hip arthroplasty?
Nikolai V., the question was asked by email. mail.

I had a hip replacement a year ago. I give myself the physical activity recommended by the doctor. Where can I find complete sets of exercises?
Galina, the question was asked by email. mail.

It's been 8 months since my hip replacement. Is it possible to sleep on the operated leg and do without a pillow between the legs?
Anna N., Minsk.

The specialists of the Republican Scientific and Practical Center for Traumatology and Orthopedics, candidates of medical sciences answer. Sciences - Andrey Borisov, Deputy Director for Medical Work; Andrey Voronovich, Leading Researcher.

Corr.: According to the WHO, by 2025 the share of diseases and injuries of the joints in the overall structure of diseases of the musculoskeletal system will almost double (today in Belarus there are more than 230,000 patients with arthrosis on dispensary records, approximately 10,000 need arthroplasty).

Damage to the joints, unfortunately, is accompanied by a permanent disability, leading to disability. When the hip joint collapses, it is unbearable to endure pain, it is impossible to walk ...

A. B.: Indeed, there is a pronounced pain syndrome, gait is disturbed, the thought of moving is frightening. Modern technologies make it possible to perform total hip arthroplasty in severe cases of the disease. Its replacement significantly reduces pain, a person can again engage in daily activities.

After the operation, sharp shaking of the joint, active sports should be avoided. If the patient continues to lead an energetic lifestyle, does not lose weight, this will cause the destruction of the prosthesis, the pain will return - a repeated (revision) operation to replace the worn joint will be required.

Corr.: What sensations you need to prepare for after the operation?

A.V.: The person may feel some resistance in the joint, especially when flexed excessively. It happens that the sensitivity of the skin around the incision is disturbed. Over time, these sensations subside, most people consider them insignificant compared to the pain and limited mobility before the intervention.

Corr.: How to prepare for the return of a loved one from the hospital?

A.V.: While the operated person will be recovering, it is necessary to make reliable railings along all steps in the house; remove movable rugs and electrical cords from the path of the patient. Provide an elevated toilet seat; a bench for taking a shower or bath (you need a brush with a long handle for washing). The chair should be stable, with a solid back and armrests, a firm cushion, so that the knees are lower than the hip joints. The same hard pillow should be placed on a car seat, on a sofa, etc. You need to take care of other little things: buy a horn with a long handle to put on and take off socks and shoes, tongs to grab objects (they will help to avoid excessive body tilt, which can damage the joint).

Corr.: What are the complications after the operation?

A. B.: The likelihood of their occurrence is low. Infection of the joint may develop, heart attacks or strokes occur. Increase the risk of complications, complicate the recovery of chronic diseases. After the sutures are removed, moisture should not be allowed to enter the wound until it is completely tightened and dries; cover it with a bandage that will protect it from irritation with clothes or stockings.

Blood clots in the veins of the legs or in the pelvic region are of particular concern after total joint replacement. The doctor prescribes one or more drugs to prevent blood clots (for example, blood thinners, elastic bandages, or stockings). It is necessary to carefully follow all the advice of a doctor. This will minimize the potential risk of blood clots at the start of the recovery period. Warning signals of their occurrence are leg pain not related to the incision site; redness of the calf; swelling of the thigh, calf, ankle, or foot. The advancement of a blood clot in the lungs is indicated by increased respiration, chest pain. If these symptoms appear, see a doctor immediately!

Contribute to the infection of the joint after surgery and dental procedures, inflammation on the skin and in the urethra. Therefore, before any surgical procedures (including at a dentist's appointment), which can lead to the entry of bacteria into the blood, you need to consult a doctor: you may need to take antibiotics. It is impossible to make intramuscular injections into the gluteal region on the operated side, which is important to warn the medical staff about.

Infection of the joint is indicated by a constant fever (> 37 0), chills, redness, soreness or swelling of the postoperative suture, discharge from the wound, increasing pain in the joint in an active and calm state. With any of these signs, you should immediately consult a doctor.

You may not have an appetite for several weeks after surgery. But you need to know that in order to heal tissue and restore strength in the muscles, a balanced high-calorie diet containing protein, vitamins and trace elements is necessary. You should drink more fluids.

Corr.: What should be the "home" rehabilitation to confidently get back on your feet after joint replacement?

A.V.: It is very important, especially in the first weeks after joint replacement, to exercise. Their complexes can be found on the website of the Republican Scientific and Practical Center for Traumatology and Orthopedics - www.ortoped.by.

A month and a half after discharge from the hospital, it is necessary to carry out simple daily activities. Consistently expand the walking program - first at home, and then on the street. Gradually increase the duration of walks, focusing on well-being; resume normal household chores. Try sitting, standing, going up and down stairs. And be sure to perform special exercises several times a day to restore mobility and strengthen the hip joint.

A. B.: I pay special attention: you can not fall! This can lead to damage to the joint or dislocation of the head of the prosthesis, which will require a second operation. Remember that stairs are a dangerous provocateur. Until the joint gets stronger and acquires mobility, it is better not to walk on them. At first, you should use crutches, a cane, lean on someone else's hand until you have enough strength and ability to maintain balance and walk without outside help and aids.

A.V.: To ensure proper recovery and prevent displacement of the prosthesis, do not place the operated limb on the other leg. It is necessary to try not to cross the conditional line of the middle of the body with the operated leg. Do not bend your leg more than 90 degrees. Sitting in one position - no more than an hour; Standing up, be sure to lean on the armrests. Do not turn your feet excessively in or out. Lie down like this: first sit on the bed, then, raising your legs, turn towards the middle of the bed. At night, you need to put a pillow between your legs until the orthopedist cancels it. Sleeping on the operated leg is also possible only with the permission of a specialist.

It is not recommended to drive a car in the first 1.5-2 months after the operation. When taking a seat in the car, you need to turn your back to the seat, lower yourself onto it and, raising your knees, turn smoothly. For the convenience of rotating the body on the seat, it is advisable to put a plastic bag.

The new joint will be detected by a metal detector during the screening at the airport, so employees must be warned in advance. Damage to the joints is accompanied by persistent disability, leading to disability. When the hip joint collapses, it is unbearable to endure pain, it is impossible to walk ...

www.medvestnik.by

Anatomy of the hip joint

The largest bone joint in the human body is the hip joint. It experiences enormous loads throughout a person's life, as it is a connection between the lower extremities and the pelvis.

Structures from which TBS is formed:

• head of the femur - the upper end of the bone in the form of a ball;
• acetabulum - a depression or funnel in both pelvic bones, in which the heads of the femur are fixed;
• articular cartilage - lines the acetabulum from the inside and is represented by soft cartilage tissue with a gel-like lubricant, is necessary to facilitate and “soften” the movement of the femoral head in the joint;
• synovial fluid - a jelly-like fluid located in the joint cavity, which provides nutrition to the cartilage, and also softens the friction between the surfaces of the joint;
• ligaments and joint capsule - consist of dense connective tissue, designed to hold the articular surfaces, ensure the stability of the hip joint and prevent its dislocation.

Movements in the hip joint are carried out due to contractions of the muscles and tendons surrounding the joint. Such a structure of the hip joint makes the bone joint mobile and provides movement in almost any plane and direction. This range of motion adequately provides support, walking and strength training.

Often, replacement of the hip joint is required after its serious injury. But often the indications for arthroplasty are past diseases of the bones and / or joints. Various degenerative processes in the hip joint cause pain and impair mobility, and in severe cases lead to the complete destruction of the femoral head and other components of the joint.

Hip replacement

Hip arthroplasty is a complex and lengthy surgical intervention, during which worn (destroyed) parts of the joint are replaced with artificial ones. The prosthesis that replaces the "old" HJ is called an endoprosthesis, as it is installed inside the (endo-) organism.

Who needs hip arthroplasty

Hip replacement is advisable only in case of serious structural damage and dysfunction of the joint, when walking and any physical activity causes pain and is almost impossible. In each case, when deciding on hip arthroplasty, the possibilities of the operation, its necessity and benefits should be taken into account.

Indications:

• degenerative-dystrophic arthrosis of the hip joint (coxarthrosis) in the case of bilateral joint damage having 2-3 degrees;
• 3 degree of coxarthrosis of one hip joint;
• coxarthrosis 2 - 3 degrees of one HJ, combined with ankylosis (complete immobility) of another HJ;
• ankylosing spondylitis or rheumatoid arthritis leading to unilateral or bilateral ankylosis of the hip joint;
• aseptic necrosis, when the head of the bone is completely destroyed, either due to circulatory disorders or as a result of trauma, which is often found in young men and is not fully explained;
• fracture of the femoral neck, usually in the elderly, fractures of the femoral head (after a fall or injury);
• the formation of a false joint (in elderly patients);
• hip dysplasia, especially congenital;
• diseases associated with metabolic disorders in the bones (osteoporosis or osteoarthritis);
• malignant neoplasms of the head or neck of the femur, both primary and metastases
• post-traumatic arthrosis;
• Perthes disease - necrosis of the head of the femur.

The main signs that signal the need for a hip replacement include:

• a significant reduction in volume in the TBS;
• stiffness of the TBS;
• severe pain, up to unbearable when moving;
• long-term pain syndrome.

Contraindications

Hip arthroplasty may not be performed in all cases. Contraindications to joint replacement are divided into absolute (the operation cannot be done at all) and relative (with caution and under certain conditions).

Relative contraindications include:

1. oncological diseases;
2. chronic somatic pathology;
3. liver failure;
4. overweight (grade 3);
5. hormonal osteopathy.

Absolute ban on surgery in case of:

• impossibility of independent movement (joint replacement is impractical and only increases the risk of complications due to surgery);
• chronic cardiovascular pathology (heart failure and severe heart defects, arrhythmias), cerebrovascular accident and decompensated hepatic and renal failure (high risk of worsening the condition);
• diseases of the bronchopulmonary system, which are accompanied by respiratory and ventilation failure (asthma, emphysema, bronchiectasis, pneumosclerosis);
• inflammatory processes in the area of ​​TBS (damage to the skin, muscles or bones);
• the presence of foci of chronic infection that need to be sanitized (carious teeth, tonsillitis, chronic sinusitis or otitis media);
• recent sepsis (3-5 years before a possible intervention) - the risk of suppuration of the endoprosthesis is high;
• multiple allergies, especially to drugs;
• paresis or paralysis of the leg to be operated on;
• severe osteoporosis and insufficient strength of bone tissue (there are high chances of breaking a leg in the thigh area even after a perfectly performed operation);
• the absence of a medullary canal in the thigh bone;
• immaturity of the skeleton;
• acute diseases of the vessels of the legs (thrombophlebitis or thromboembolism).

Types of endoprostheses

An artificial joint, which is used to replace a pathologically altered hip joint, must have the following characteristics:

1. sufficient strength;
2. fixation reliability;
3. high functional abilities;
4. inertness (biocompatibility) to body tissues.

The load on the artificial joint is greater than on your own due to the lack of cartilage and synovial fluid, which reduce the load and friction. Therefore, for the manufacture of endoprostheses, high-quality metal alloys, polymers (very durable plastic) and ceramics are used. Usually, all the listed materials are combined in one endoprosthesis, more often a combination of metal and plastic - combined artificial joints.

The most durable and resistant to wear are metal endoprostheses, their service life is 20 years, while the rest is no more than 15 years.

The artificial joint consists of:

• the endoprosthesis cup, which replaces the acetabulum of the pelvic bones, is made of ceramic or metal (but there is also plastic);
• endoprosthesis heads in the form of a spherical metal part with polymer coating, which ensures soft sliding of the endoprosthesis during leg movements;
• the stem of the prosthesis, which bears the maximum load, is therefore made only of metal (the stem of the endoprosthesis replaces the neck and the upper third of the femur bone).

Endoprostheses by type of hip arthroplasty

The classification of artificial joints for hip arthroplasty includes their division into:

Single pole

They consist only of a stem and a head, which replace the corresponding parts of the femoral bone, while the acetabulum remains its own “native”. Such surgeries used to be performed frequently, but due to poor functional results and a large number of destruction of the acetabulum, which leads to the failure of the prosthesis into the small pelvis, they are rarely performed today.

Bipolar

Such endoprostheses are called total and are used in total hip arthroplasty. During the operation, not only the femoral head and neck are replaced, but also the acetabulum (an endoprosthesis cup is installed). Bipolar endoprostheses are well fixed in the bone tissues, adapted as much as possible, which increases the success of the operation and reduces the number of complications. Such endoprostheses are suitable both for endoprosthesis replacement of elderly patients with osteoporosis and for young active people.

Types of implant fixation

The success of the operation is ensured not only by the correct choice of the endoprosthesis, but also by the method of its installation. The goal of hip arthroplasty is to secure the implant to the bone as firmly and reliably as possible in order to provide the patient with free movement in the leg after the operation.

Prosthesis fixation options:

Cement

For such installation of the implant, a special biological glue, the so-called cement, is used, which, after hardening, firmly fixes the endoprosthesis to the bone tissues. The cement is prepared during the operation.

Cementless

This fixation of the implant is based on its special design. The surface of the endoprostheses is provided with many small protrusions, recesses and holes. After some time, the bone tissue grows through the holes and recesses, thus forming a single system with the implant.

hybrid

Mixed implant placement combines cemented and cementless attachment methods. This option involves screwing the endoprosthesis cup into the acetabulum and fixing the stem with cement.

The choice of implant fixation option is determined by the anatomical features of the bone and the medullary canal, and, of course, the patient's age. Both cement and cementless fixation have pros and cons:

• high temperature of the surrounding tissues during cement hardening, which increases the risk of implant rejection or its failure into the pelvic cavity;
• on the other hand, with cement fixation, the rehabilitation period is reduced, but the use of such fixation in elderly patients and in the presence of osteoporosis is limited;
• cementless fixation increases the rehabilitation time, but is preferable for young people, as they may need to replace the endoprosthesis (re-endoprosthetics);
• hybrid fixation is the gold standard for arthroplasty and is suitable for both young and old patients.

Preparation and progress of the operation

The decision on hip arthroplasty is made by the orthopedic doctor together with the patient. In addition to the necessary diagnostic procedures (radiography, MRI and ultrasound of the operated area), the doctor examines the legs, reveals the features of the pathology and the degree of damage to the bone structures. During the examination, a suitable endoprosthesis is selected for this patient.

Additional studies and analyzes are also assigned.

Before the operation

The patient is hospitalized a day or two before the scheduled date of arthroplasty. In the hospital are appointed:

• UAC and OAM;
• blood glucose;
• blood chemistry;
• blood clotting analysis (platelets, prothrombin, prothrombin index, bleeding and clotting time);
• blood group and rhesus;
• blood electrolytes;
• tests for HIV infection, syphilis and hepatitis;
• radiography of the lungs;
• determination of respiratory functions;
• according to indications of consultation of other experts.

The patient is informed about the possible complications during and after the operation, they take a written consent to the operation and are instructed how to behave during and after the operation.

Examination of the anesthesiologist includes the choice of anesthesia, preference is given to spinal anesthesia - "prick in the back" (less harmful and optimal for elderly patients).

On the eve of the operation, a light dinner is allowed. In the morning, the skin in the area of ​​the hip joint is carefully shaved, the legs are bandaged with elastic bandages or compression stockings are put on. In the morning, the patient is not allowed to drink and eat.

Operation progress

After transporting the patient to the operating room, anesthesia is performed and the surgical field is treated with antiseptics. The surgeon dissects the skin and muscles (up to 20 cm in length) and opens the intra-articular capsule and brings the femoral head into the wound. Then he resects the femoral bone, including the head and neck, and exposes the bone canal.

The bone is modeled according to the shape of the implant, which is fixed in the bone canal in the most appropriate way (more often with the help of cement). The acetabulum is treated with a drill and the articular cartilage is completely removed. The cup of the endoprosthesis is installed and fixed in the treated funnel.

The final stage of the operation is suturing the dissected tissues and installing a drain in the wound to drain the discharge. A bandage is applied.

The duration of the operation is 1.5 - 3.5 hours.

Possible Complications

The question of complications of hip arthroplasty is often of interest to patients. Any surgical intervention carries the risk of failure. Hip arthroplasty is a very complex and extensive operation, and even with contraindications, correctly selected indications, compliance with the rules and postoperative recommendations, adverse results are possible.

All complications of this surgical treatment are divided into 3 groups:

• During the operation

This group includes the development of bleeding in the wound, an allergy to drugs or a violation of cardiac activity, less often thromboembolism and fracture of the bone formations of the joint.

• In the early recovery period

There may be bleeding from the wound, suppuration of the wound or implant, hematoma of the operated area, failure of the endoprosthesis with its rejection, osteomyelitis, anemia, or dislocation of the hip joint.

• distant

Similar complications develop after the patient is discharged from the hospital. These include dislocation of the endoprosthesis, the formation of rough scars in the postoperative area, which reduces mobility in the joint or loosening of parts of the articular prosthesis.

Let's talk about prices

All, without exception, patients are interested in whether the operation is paid, and if so, what is the cost of arthroplasty. In Russia, today it is possible to perform surgical treatment of the hip joint according to the following programs:

• free of charge, if you have a compulsory medical insurance policy (as a rule, in this case there is a queue for 6-12 months);
• free of charge under the VMP quota (high-tech medical care) - certain circumstances are needed for which benefits are provided;
• for a fee in a public or private clinic.

When buying an artificial joint, you should not be based on price, but on the model, diagnosis and age of the patient. For example, an endoprosthesis for surgery for coxarthrosis will cost more than an implant needed for a fracture of the femoral neck. So the operation is very complicated, the professionalism of the surgeon and the virtuosity of performance are important, and not an expensive implant. In the case of a medical error, the development of negative results can be with the highest quality and most expensive endoprosthesis.

Only a doctor will be able to choose the optimal implant model, so it is better to entrust the choice of an endoprosthesis to the operating surgeon.

The most popular implant models are produced by international companies such as DePuy and Zimmer.

When choosing an endoprosthesis, one should take into account the material from which the components of the implant are made:

• metal / metal - such a combination is resistant to wear, the service life is 20 years or more, ideal for men with an active lifestyle, but not recommended for women who are planning a pregnancy (high risk of metal ions entering the fetus); the price is quite high and the formation of toxic products on the surfaces of the endoprosthesis during friction is possible, therefore they are rarely used;
• metal/plastic - an inexpensive implant, the toxicity of friction products is moderate, but short-lived design (no more than 15 years); suitable for people with an unsportsmanlike character, leading a calm lifestyle and available to pensioners;
• ceramics / ceramics - good for any age and gender, they are durable and non-toxic, but expensive (as a drawback, they can creak when moving);
• ceramics / plastic - they are cheap, wear quickly and are short-lived, optimal for older men and women.

The cost of arthroplasty consists of the cost of the implant, the cost of the operation, plus the hospital stay. For example, the minimum price of a DePuy endoprosthesis is $400, and that of Zimmer is $200. The average cost of surgical treatment ranges from 170,000 to 250,000 rubles, and together with a stay in the hospital up to 350,000. In total, the financial costs of treatment will be about 400,000 rubles.

Rehabilitation and life with a prosthesis

Rehabilitation after hip arthroplasty is an important and lengthy process that requires great patience and perseverance from the patient. It depends on the patient how the leg will move in the future and whether he will return to his usual way of life.

After hip arthroplasty, all measures taken are aimed at restoring motor activity in the operated joint and should begin immediately (after recovery from anesthesia) after surgery. Rehabilitation includes:

• early activation of the patient, all activities should be performed continuously, sequentially and in a complex;
• physiotherapy exercises;
• breathing exercises;
• massotherapy;
• taking vitamins and minerals that strengthen bones and joints;
• balanced diet;
• limitation of physical activity and sports activities.

There are 3 recovery periods:

1. early postoperative, which lasts up to 14 - 15 days;
2. late postoperative, lasts up to 3 months;
3. remote - from 3 to 6 - 12 months.

Operation: first day

The first day of the postoperative period, the patient is in the ICU (intensive care unit), where they monitor vital signs and prevent the development of possible complications. After the operation, antibiotics, coagulants are prescribed, and the legs must be bandaged with elastic bandages (to prevent blood stasis). The bandage is changed and the urinary catheter is removed the next day. The first exercises after surgery, the patient should begin immediately after recovery from anesthesia:

• wiggling toes - bend and unbend;
• bend and unbend the foot in the ankle joint back and forth (about 6 sets per hour in a few minutes, until the foot is slightly tired);
• rotation of the foot of the operated leg 5 times in one direction (clockwise) and 5 times in the other;
• movements with a healthy leg and arms without restriction;
• slight flexion in the knee of the operated leg (smooth sliding of the foot along the sheet);
• alternate tension of the left and right gluteal muscles;
• alternately lifting one or the other straightened leg 10 times;

All exercises on the first day and later must be combined with breathing exercises (prevention of congestion in the lungs). When the muscles are tense, you should take a deep breath, and when relaxing, exhale slowly.

It is forbidden to sit down and walk on the first day. Also, you can not fit on your side, you can only half-side with a pillow between your legs.

While the patient is in a horizontal position, especially in people with somatic diseases of the heart, bronchopulmonary system, he is prevented from forming bedsores (change of body position, massage of the skin over bony prominences and back, regular change of clothes, treatment with camphor for alcohol).

Second - tenth day

On the second day, the patient is transferred to the general ward and the motor regime is expanded. Sitting up in bed can be tried already on the 2nd day after the operation, preferably with the help of medical staff. When you try to sit up, you need to help yourself with your hands, and then lower your legs off the bed. It is important to sit, leaning back, placing a roller behind your back. You should also remember the main rule: the angle of flexion in the hip joint should not exceed 90 degrees, that is, the hip joint should not overextend, which is fraught with dislocation of the implant or damage to its components. To comply with this rule, you just need to ensure that the TBS is above the knee.

Doctors allow taking the first steps on the second or third day. The patient should be prepared for the pain that occurs in the first days after arthroplasty. The first steps are also carried out with the support of the medical staff. The patient must be provided with a special frame (walkers) or crutches. Walking without crutches is possible only one and a half to 3 months after the operation.

When moving to a standing position, you must follow certain rules:

• first, the operated limb is hung down with the help of hands and a healthy leg;
• leaning on a healthy leg with the help of crutches, try to get up;
• the operated leg should be suspended, any attempt to lean on it with all the weight for a month is prohibited.

If the recovery period proceeds satisfactorily, then after a month it is allowed to use a cane instead of crutches as a means of support. It is strictly forbidden to lean on a sore leg for the first month after surgery.

• alternately bend at the knee and raise either one or the other leg - an imitation of walking in place, but relying on the back of the bed;
• standing on a healthy leg, take aside and bring the operated limb to its original position;
• standing on a healthy leg, slowly and smoothly take the sore leg back (do not overdo it) - extension of the hip joint.

It is allowed to roll over in bed on the stomach from 5 to 8 days, and the legs should be somewhat apart and with the help of a pillow between the thighs.

The intensity of the load and the expansion of the range of motion should increase gradually. The transition from one type of exercise to another should not be made earlier than 5 days.

As soon as the patient began to confidently get out of bed, sit down and walk on crutches for more than 15 minutes three times a day, they include training on an exercise bike (10 minutes once or twice a day) and begin to learn to walk up the stairs.

When lifting, first a healthy leg is placed on the step, then the operated leg is carefully substituted for it. When descending to the lower step, crutches are transferred, then the operated limb, and then a healthy one.

Long-term rehabilitation period

The final stage of recovery begins 3 months after arthroplasty. It lasts up to six months or more.

A set of exercises to perform at home:

• lie on your back, bending and pulling your right and left legs to your stomach in turn, as when riding a bicycle;
• lie on a healthy side (pillow between the thighs), raise the operated straight leg, maintain the position as long as possible;
• lie on your stomach and bend - unbend the limbs at the knees;
• lie on your stomach, raise a straight leg and take it back, then lower it, repeat with the other limb;
• perform semi-squats from a standing position, leaning on the back of a chair / bed;
• lying on your back, alternately bend your legs at the knees, without lifting your feet from the floor;
• lying on your back, alternately take one and the other leg to the side, sliding along the floor;
• put a pillow under your knees and alternately unbend your legs at the knee joints;
• standing, leaning on the back of a chair, lift the operated leg forward, then take it to the side, then back.

Apartment preparation

In order to avoid possible difficulties after the patient is discharged from the hospital, an apartment should be prepared:

Remove all carpets to prevent feet or crutches from catching on them.

• Walls

Place special handrails in places of increased danger: in the bathroom and toilet, in the kitchen, next to the bed.

• Bed

If possible, purchase a medical bed, in which you can change the height. It is not only comfortable to rest on it, but also easier to sit down and get out of bed.

• Bathroom

It is advisable to wash in the bath or take a shower while sitting, or by placing a special board on the edges of the bath, or by placing a chair with non-slip legs in the shower cabin. Fix a handrail on the wall near the bath to facilitate the process of getting up and squatting in the bath.

• Toilet

The patient must remember the rule - the angle of flexion in the hip joint should not exceed 90 degrees. But the standard height of the toilet bowl does not allow this rule to be observed, therefore, either an inflatable ring or a special nozzle is placed on the toilet bowl. Handrails are also installed on the walls next to the toilet to make it easier to sit down and stand up.

What is allowed and what is prohibited

After the operation, no matter how long ago it was performed, it is strictly prohibited:

• sit on a low surface (chairs, armchairs, toilet bowl);
• cross your legs, lying on your side or on your back;
• sharp turns of the body with fixed legs and pelvis (back or sideways), you should first rearrange the legs in the right direction;
• lie on your side without a cushion between your knees;
• sit cross-legged or cross-legged;
• sit for more than 40 minutes.

It is possible after arthroplasty:

• rest in a horizontal position on the back up to 4 times a day;
• dress only while sitting, put on stockings, socks and shoes with the help of relatives;
• when sitting, spread the feet at a distance of 20 cm;
• do simple household chores: cooking, dusting, washing dishes;
• walk independently (without support) after 4 to 6 months.

Question answer

Due to the fact that the patient's motor activity is reduced after the installation of the implant, the caloric intake should be monitored to prevent weight gain, which slows down the patient's recovery. You should abandon fatty and fried foods, pastries and confectionery, marinades, smoked meats and seasonings. It is necessary to expand the diet with fresh and baked fruits and vegetables Lean meats (beef, veal, chicken) and fish. Strict ban on alcohol, strong tea and coffee.

If the postoperative period proceeded without complications, then discharge from the hospital is carried out on the 10th - 14th day, immediately after the removal of the sutures.

The drainage is removed after the outflow of the discharge stops, as a rule, this happens on the 2nd - 3rd day.

It is necessary to undergo an examination by the operating doctor and make sure that everything is in order with the endoprosthesis. If there are no complications, you should consult a neurologist, perhaps the pain is associated with lumbar osteochondrosis.

No. Doctors do not recommend surgery for persons under 45 years of age. Firstly, this is due to the limited operation of the implant (maximum up to 25 years), and, secondly, in young patients, the endoprosthesis wears out faster due to physical activity.

Yes, it is possible, but it is performed extremely rarely and for health reasons (more often after an injury). Double arthroplasty increases the likelihood of postoperative complications and aggravates the recovery period.

X-ray examination is carried out 3 months after implantation of the endoprosthesis in order to determine the state of fixation of the implant and bone structures.

Hand hygroma operation

Full title:

Complications of hip arthroplasty

Slobodskoy A.B., Osintsev E.Yu., Lezhnev A.G. (GUZ Saratov Regional Clinical Hospital)

"Bulletin of Traumatology and Orthopedics", 2011, No. 3

An increase in the number of arthroplasty of large joints, and primarily of the hip joint, is observed in most countries of the world, including Russia (9, 11). Despite the improvement in the quality of implants used, the improvement of endoprosthesis technologies, and the accumulation of practical experience among surgeons, the percentage of complications and unsatisfactory outcomes of arthroplasty remains quite high. So, according to a number of authors, dislocations of the endoprosthesis head occur in 0.4-17.5% of cases (2, 3, 4, 14, 15), purulent-inflammatory complications in 1.5-6.0% (7, 8, 10, 13, 15, 18), periprosthetic fractures in 0.9% - 2.8% (1, 15, 18, 19), postoperative neuritis in 0.6 - 2.2% (1, 16, 17 ), thromboembolic complications in 9.3 - 20.7% (5, 6, 18). It has been proven that the same complications after previous operations on the joint (osteotomy, osteosynthesis, etc.), as well as after revision arthroplasty, increase significantly (12, 16). Thus, the study of the causes and development of ways to prevent the most common complications of hip arthroplasty have been and remain topical issues of traumatology and orthopedics.

Purpose of the study

To study the nature and frequency of complications of hip arthroplasty, to determine their possible causes and ways of prevention.

Materials and methods

In the period from 1996 to the present, under our supervision there were 1399 patients who underwent 1603 operations of primary hip arthroplasty. 102 patients were operated on from 2 sides. 584 men were treated, women - 815. The age of the patients was from 18 to 94 years. Of these, younger than 25 years - 20; from 26 to 40 years old - 212; from 41 to 60 years old 483; and older than 60 years 684 patients. As implants for hip arthroplasty, the ESI endoprosthesis (Russia) was used in 926 cases, Zimmer (USA) in 555, De Pue (USA) - 98, Seraver (France) - 18, Mathis (Switzerland) - 6. Cementless fixation of components endoprosthesis was used in 674 operations, hybrid in 612 and fully cemented in 317 cases. Operations of revision hip arthroplasty were performed in 111 in 106 patients. In 5 cases, the revision was performed on 2 sides. The ratio of primary and revision arthroplasty operations was 1:14. Men 49, women 57. The age of patients is from 42 to 81 years. Oncological endoprostheses of the hip joint were implanted in 19. Reinforcing structures (Muller rings, Bursch-Schneider) were used in 22 operations. Operations for dysplastic coxarthrosis and in other complex cases were performed 267.

Research results

We analyzed postoperative complications: by age groups, depending on the indications for primary arthroplasty, in groups of patients with comorbidities (diabetes mellitus, rheumatoid arthritis), with primary and revision arthroplasty, with uncomplicated primary arthroplasty and arthroplasty in difficult cases, with arthroplasty with domestic and imported implants.

The nature and frequency of complications of hip arthroplasty (in the numerator - absolute numbers, in the denominator - percentages):

It can be seen from the analysis of the table that 69 complications of various nature were diagnosed for 1603 operations, which amounted to 4.30±0.92%. The most frequent were dislocations of the endoprosthesis head - 31 cases (1.93±0.44%) and purulent-inflammatory complications - 22 cases (1.37±0.44%). Other complications of hip arthroplasty (periprosthetic fractures, postoperative neuritis, telas) were isolated and were observed in less than 0.5%.

The nature and frequency of complications of hip arthroplasty, depending on the age of the patients (in the numerator - absolute numbers, in the denominator - percentages):

As can be seen from the table, there is a direct pattern of increase in the number of complications with age. Thus, purulent-inflammatory complications in patients under 25 years of age were not observed at all, at the age of 26 to 40 years they occurred in 3 patients (0.18%), at the age of 41 to 60 years in 6 (0, 37%), and over 60 years old in 13 (0.81%). Dislocations of the endoprosthesis head in the postoperative period were also observed more often in older patients. Thus, in groups of patients younger than 60 years they were diagnosed in 9 cases (0.54%), and in the group older than 60 years in 22 cases (1.37%). Periprosthetic fractures occurred in three patients (0.18%) over 60 years of age. Neuritis of the peroneal nerve complicated the course of the postoperative period in 1 patient (0.06%) aged 35 years, 3 patients (0.18%) in the age group from 41 to 60 years and in 4 patients (0.24%) older than 60 years . Pulmonary embolism occurred in one patient at the age of 57 years and in 4 patients (0.24%) over 60 years of age, in three of them it ended in death.

The total number of complications in the group of patients younger than 25 years old was 1 (0.06%), in the group of patients from 26 to 40 years old - 8 (0.48%), in the age group from 41 to 60 years old - 14 (0.87% ) and in the older age group (over 60 years) - in 46 patients (2.87%).

The nature and frequency of complications of hip arthroplasty, depending on the etiology (in the numerator - absolute numbers, in the denominator - percentages):

Nosological forms Character Complications	Idiopathic coc-arthrosis	Dis-plastic coxar-troz	Aseptic necrosis of the head	Acute prox injury. femoral department. bones	Prox injury consequences. femoral department. bones	Revisions, complex endoprostheses.	TOTAL
Purulent - inflammatory	1/0,06	3/0,18	2/0,12	4/0,24	4/0,24	8/0,48	22/1,37
Dislocations of the endoprosthesis head	2/0,12	4/0,24	2/0,12	6/0,36	8/0,48	9/0,54	31/1,93
Periprosthetic fractures	-	1/0,06	-	-	1/0,06	1/0,06	3/0,18
Postoperative neuritis	-	-	-	4/0,24	2/0,12	2/0,12	8/0,48
TELA	-	-	-	2/0,12	-	3/0,18	5/0,30
TOTAL	3/0,18	8/0,48	4/0,24	16/0,99	15/0,93	23/1,43	69/4,35

From the analysis of the table, the following conclusions can be drawn. A greater number of complications of hip arthroplasty was observed in groups of patients who underwent revision arthroplasty and arthroplasty with complex cases. So, in this group, purulent-inflammatory changes occurred in 8 patients (0.48%), dislocations of the endoprosthesis head in 9 patients (0.54%), and in total complications were diagnosed in 23 patients (1.43%). Somewhat less frequently, complications occurred in patients with acute trauma of the proximal femur - 16 patients (0.99%) and with the consequences of trauma to the proximal femur - 15 patients (0.93%). Thus, purulent-inflammatory complications were observed in 8 patients (4 in each group), 0.24% in each group. Dislocations of the endoprosthesis head in these groups occurred in 6 patients (0.48%) and 8 patients (0.54%), respectively. Among patients operated on for diseases of the hip joint, the largest number of complications was noted in the group of patients with dysplastic coxarthrosis - 8 patients (0.48%). In patients with idiopathic coxarthrosis and aseptic necrosis of the femoral head, the number of complications was 2–2.5 times less than in dysplastic coxarthrosis.

The nature and frequency of complications of hip arthroplasty depending on the comorbidity (in the numerator - absolute numbers, in the denominator - percentages):

Diseases Character Complications	Diabetes	Systemic diseases	Other diseases and without concomitant. pathology	TOTAL
Purulent - inflammatory	7 /0,44*	11 /0,67*	4 /0,24	22/1,37
Dislocations of the endoprosthesis head	2 /0,12	1 /0,06	28 /1,75	31/1,93
Periprosthetic fractures	-	1 /0,06	2 /0,12	3/0,18
Postoperative neuritis	1 /0,06	3 /0,18	4 /0,24	8/0,48
TELA	1 /0,06	1 /0,06	3 /0,18	5/0,30
TOTAL	11 / 0,67	17 /1,06	41 /2,56	69/4,35

* in total, 72 patients with diabetes mellitus were operated on, and 83 patients with systemic diseases, thus, in the group of patients with diabetes mellitus, purulent-inflammatory complications were 9.7%, and in systemic diseases - 13.2%

Analyzing the number and nature of complications in patients with various comorbidities, it should be noted that dependence is possible only in the group of purulent-inflammatory complications. The rest of the considered complications in most cases do not depend on changes in the body associated with concomitant diseases. Thus, the greatest number of complications of a purulent-inflammatory nature was observed in patients with systemic diseases. They were diagnosed in 11 patients of this group. (0.67%) Somewhat less often these complications were observed in various forms of diabetes mellitus - 7 patients (0.44%). And in patients with other diseases or without concomitant pathology, they were noted only in 4 cases (0.24%). No regularity in the development of non-inflammatory complications with concomitant pathology was found.

The nature and frequency of complications of hip arthroplasty, depending on the manufacturers of implants:

Manufacturer Character Complications	domestic producers	Import manufacturers	TOTAL
Purulent - inflammatory	12 /0,75	10 /0,62	22/1,37
Dislocations of the endoprosthesis head	15 /0,94	16 /0,99	31/1,93
Periprosthetic fractures	2 /0,12	1 /0,06	3/0,18
Postoperative neuritis	4 /0,24	4 /0,24	8/0,48
TELA	3 /0,18	2 /0,12	5/0,30
TOTAL	36 /2,24	33 /2,11	69/4,35

Analyzing the data, it can be noted that, both quantitatively and qualitatively, the complications that developed after hip arthroplasty with implants from different manufacturers do not differ. Differences in the presented groups are not statistically significant. However, it would not be objective to draw conclusions about the quality of certain implants based only on postoperative complications. Therefore, we conducted an analysis on the duration of the "life of the joints", i.e. according to the timing of the development of aseptic instability when using endoprostheses from different manufacturers. Terms of development of aseptic instability of components after hip arthroplasty (in the numerator - absolute numbers, in the denominator - percentages):

As can be seen from the table, the number of cases of aseptic loosening of the components of hip joint endoprostheses, as well as the timing of its development in domestic and foreign manufacturers, is almost the same, the existing differences are not statistically significant.

Discussion of the results of the study

Having considered the data on the nature of complications after hip arthroplasty and their frequency depending on age, the indication for surgery, comorbidities, as well as the implants used, a number of patterns are noted.

The increase in complications with age is primarily due to the fact that the number and severity of concomitant diseases increase in the elderly, and resistance to infection decreases. In addition, in elderly patients, reparative and restorative functions are weakened, the tone of the musculoskeletal apparatus decreases, osteoporosis increases, and the risk of bone fractures increases. All this explains a significant increase in the number of purulent-inflammatory complications, as well as dislocations of the femoral head by 2-4 times. Thromboembolic complications, including those leading to a fatal outcome, were diagnosed only in patients older than 60 years.

A clear pattern in the development of certain complications can also be traced depending on the indications for hip arthroplasty. So, with revision arthroplasty and arthroplasty in difficult cases, the number of complications of a purulent-inflammatory nature, as well as dislocations of the endoprosthesis head, is 2.5-3 times higher, and with dysplastic coxarthrosis 1.5-2 times higher than with endoprosthetics for idiopathic coxarthrosis and aseptic necrosis of the femoral head. In acute trauma of the proximal femur and in patients with the consequences of this injury, the number of purulent-inflammatory complications and dislocations of the endoprosthesis head was 1.5-2.5 times higher than those operated on for degenerative diseases of the hip joint. It is characteristic to note that such complications as pulmonary embolism and postoperative neuritis were noted only after revision arthroplasty, arthroplasty in difficult cases and due to injuries of the proximal femur. The above pattern is quite understandable. Revision arthroplasty operations, operations after previously performed osteotomies, osteosynthesis, failed arthrodesis, and others that are classified as arthroplasty in difficult (or special) cases, are performed under completely different conditions than conventional primary arthroplasty. These operations are characterized by gross violations of the normal anatomy of the hip joint. They develop due to the presence of a rough cicatricial adhesive process in the wound, the presence of bone defects in the area of ​​the acetabulum and the proximal femur, deformation of various parts of the bones that make up the hip joint. Anatomical features of dysplastic coxarthrosis are well known. Bone mass deficiency, deformation of the acetabulum, head, neck, proximal femur, pathology of the musculoskeletal apparatus of the hip joint cause the operation to be carried out in much more difficult conditions than with uncomplicated arthroplasty, increases its time and blood loss. The increase in the number of almost all complications in acute trauma and its consequences is explained by the predominant lesion of this pathology in the older age group, an increase in the number of concomitant diseases, and the progression of osteoporosis.

Complications of a purulent-inflammatory nature after hip arthroplasty in systemic diseases and diabetes mellitus were observed 1.5-2.5 times more often than with other concomitant pathologies or without it at all. It is known that both in diabetes mellitus and in many systemic diseases (rheumatoid arthritis, systemic lupus erythematosus, nonspecific arthritis, etc.), homeostasis disturbances of varying severity are observed. Violations of microcirculation, innervation, ischemic changes in tissues, as well as changes in carbohydrate, protein, fat metabolism cause a decrease in indicators of specific and nonspecific immunity, violations of the regenerative function of tissues. Thus, the increase in the number of complications in diabetes mellitus and systemic diseases is quite natural. Changes in the number of complications of hip arthroplasty of a non-inflammatory nature in the direction of increase or decrease, depending on the comorbidity, were not observed.

An important criterion used to analyze the incidence of complications after hip arthroplasty is the quality of the implant used. It is a well-known opinion, both at the household level and among many traumatologists - orthopedists, that imported hip joint endoprostheses are better, domestic ones are worse. This opinion is not supported by any objective criteria other than subjective assessment. In this regard, we conducted an analysis both for individual groups of complications, as well as for their number in patients who were implanted with endoprostheses of various manufacturers. From domestic manufacturers, endoprostheses were used by ESI (Moscow) - 926 operations, Zimmer (USA) - 555, De Pue (USA) - 98, Seraver (France) - 18, Mathis (Switzerland) - 6. It was found that the total number of complications when using domestic implants, there were 36 cases, and imported - 33, respectively 2.24% and 2.11%. Complications of a purulent-inflammatory nature were diagnosed in 0.75% when using domestic endoprostheses and in 0.62% when using imported ones. Dislocations of the endoprosthesis head occurred in 0.94% and 0.99%%, respectively, periprosthetic fractures in 0.12% and 0.06%%, postoperative neuritis developed in 4 patients in each group (0.24%), and pulmonary embolism complicated the course of postoperative period in 3 patients in the 1st group (0.18%) and in 2 patients in the 2nd group (0.12%). Analyzing the timing and frequency of development of aseptic instability of endoprosthesis components, it can be noted that in the early stages after surgery (up to 3 years), this complication was observed in isolated cases - in 2 patients with endoprosthesis replacement by ESI and in 1 - by Zimmer. In the interval from 3 to 5 years, joint instability was not observed at all. In the period from 5 to 8 years after surgery, approximately the same number of cases of aseptic loosening of joint components was noted, in both groups - 2-3 patients each (0.18%). And after 10 years from the moment of the operation, aseptic loosening of the joints was noted in 6 patients who were implanted with domestic endoprostheses (0.36%) and the same number after arthroplasty with imported implants. Thus, assessing the number of complications and aseptic loosening of hip endoprostheses of domestic and foreign manufacturers, it can be noted that there were no statistically significant differences both in quantitative and qualitative terms.

Thus, the problem of complications after various types of hip arthroplasty remains not just relevant, its significance increases every year, with a progressive increase in the number of arthroplasty operations. The group of risk factors for the development of various complications includes advanced age of patients, severe comorbidities (diabetes mellitus, rheumatoid arthritis and other systemic diseases), acute trauma of the proximal femur, surgery for dysplastic coxarthrosis, revision and complex hip arthroplasty. In these cases, the risk of complications increases by 1.5 - 3.5 times. Purulent - inflammatory process in the hip joint in history, as well as each repeated operation on the hip joint increases the risk of complications in the postoperative period at times. We did not note differences in the number of complications, the timing of the development of aseptic instability, depending on the manufacturers of the implants used.

Conclusions:

1. In hip arthroplasty, various complications occur in 4.3% of cases. Including purulent - inflammatory - in 1.37%, dislocation of the endoprosthesis head in 1.93%, periprosthetic fractures in 0.19%, postoperative neuritis in 0.49% and pulmonary embolism in 0.31% of cases.
2. Risk factors for the development of complications of arthroplasty include advanced age of patients, severe comorbidities (diabetes mellitus, rheumatoid arthritis and other systemic diseases), acute trauma of the proximal femur, surgery for dysplastic coxarthrosis, revision and complex hip arthroplasty, purulent-inflammatory processes in history of the hip joint.
3. There is a clear pattern between the increase in the complexity of the operation, the performance of each subsequent operation on the joint and the increase in the number of complications, especially of a purulent-inflammatory nature and dislocations of the endoprosthesis head.
4. Dependence of the number of complications and terms of development of aseptic instability depending on the manufacturer of endoprostheses was not observed.