How to live with a hip replacement: practical advice

A dual mobility prosthesis looks like this: one implant head is fixed into the other. That, in turn, is placed in a metal cup. This design reduces the likelihood of dislocation and allows for a greater range of motion. The system is recognized as one of the most reliable options for revision surgery. Well suited for elderly patients with weakened muscles and cognitive dysfunction. Global brands produce lines with a variety of sizes of endoprostheses. The selection of the ideal one is carried out based on X-ray images of the joint; the final decision on which components of the implant to install is made directly during the operation.

What is an endoprosthesis?

The successful outcome of surgery largely depends on the quality of the endoprosthesis used, so the patient consults with a specialist in advance and selects a suitable model. When selecting, not only the budget is taken into account, but also the advantages and disadvantages of specific models, taking into account the patient’s pathology.

There are 3 types of fixation of endoprostheses - cementless, cement, hybrid. The design of the cementless model includes a liner, a bowl, a support leg, and a head. The cement model has a similar design, but the liner and bowl are not separated. By design, all models are divided into 2 types - single-pole and double-pole. The former are used to restore the head of the femoral neck, and the latter for the head and acetabulum.

At CELT you can consult an orthopedic traumatologist.

• Initial consultation – 3,000
• Repeated consultation – 2,000

Make an appointment
Standard prosthetics - 195,000 - 240,000 rubles.

Non-standard prosthetics - 270,000 - 320,000 rubles.

Included in the price:

the operation, consultation with an anesthesiologist and anesthetic care, dressings, medications, food and hospital stay, postoperative observation by the attending physician for a month (longer if necessary). The indicated price does not include the price of the endoprosthesis itself (it may vary depending on the manufacturer) and the preoperative examination.

1-3 hours

(duration of operation)

5-8 days in hospital

Indications

• femoral neck fracture
• pseudoarthrosis of the femoral neck
• aseptic necrosis of the femoral head
• hip dysplasia and congenital hip dislocation
• tumors of the proximal femur
• infectious (including tuberculosis) coxitis
• rheumatoid arthritis and other systemic diseases with the development of stage 3 coxarthrosis;
• unsuccessful results of previous operations

Contraindications

Absolute contraindications:

• diseases of the cardiovascular and respiratory systems, metabolic disorders in the stage of decompensation
• the presence of an active focus of purulent infection in the body
• hemiparesis on the side of the planned operation
• mental or neuromuscular disorders that prevent rehabilitation after surgery
• acute vascular diseases of the lower extremities (thrombophlebitis, thrombosis)

Relative contraindications:

• severe obesity
• severe cancer
• lack of conviction of the patient himself in the need for endoprosthetics and his unpreparedness for postoperative rehabilitation

Rehabilitation after surgery

During the first 7-10 days after surgery, the patient remains in the ward. By day 2-3, he can already stand up independently and walk with crutches or support. During this period, he is prescribed courses of painkillers, anti-inflammatory and antibacterial drugs to prevent postoperative complications.

While the patient is hospitalized, he undergoes a course of restorative physiotherapy, including:

• therapeutic exercises to restore hip mobility and muscle tone;
• massage and rubbing intended to improve blood flow in the tissues of the joint, their healing and the prevention of thrombophlebitis of the operated limb.

After a period of hospitalization, the patient returns home, where he also continues to take prescribed medications and perform therapeutic exercises. Here he begins to move, first with the support of crutches or with the support of another person, then independently, gradually increasing the duration of walks. During rehabilitation, he is recommended to wear compression garments and regularly visit a doctor to check the condition of the joint.

Design features of endoprostheses for the hip joint

More than 1000 types of endoprostheses are presented, since all joints are unique and there is a strict difference in shape and size. But for successful engraftment, it is necessary to treat the femoral canal (this will preserve 100% functionality of the joint).

Models with a cementless stem have a rough structure, allowing bone tissue to grow into the material. Experts call this installation method a “tight fit.” The leg is screwed into the femoral canal and tightly fixed. For endoprostheses of this type, titanium alloys are used, onto which calcium hydroxyapatite is applied (due to this, better compatibility with the tissues of the human body is achieved).

All technological laboratories create unique solutions, which allows you to select a model taking into account the severity of the pathology and the individual structure of the patient’s hip joint. For better fastening, arcs, protrusions, ribs, etc. are used in the channel. The selection of a suitable fastening is carried out after an x-ray or x-ray.

There are also differences in the shape of the legs, as curved, flared and straight models are available. The cross section can be 4-angled or round. All differences are thought out in order to ensure an even load on the joint.

Preparing for surgery

The patient undergoes a comprehensive examination. Instrumental studies include: radiography, MRI or CT of the hip joint, ultrasound of the abdominal organs. Standard preparation before surgical treatment includes:

• general, biochemical blood test;
• coagulogram;
• blood type, Rh factor;
• blood for HIV, hepatitis, syphilis;
• general urine analysis;
• FGDS;
• ECG;
• X-ray of the lungs;
• consultation with a therapist.

If there are foci of chronic infection, sanitation is carried out to eliminate them. The patient should prepare to return home after surgery. All objects in the house should be located in accessible places so that there is no need to stretch or squat. You need to make room for walking on crutches, remove wires from the floor, move furniture away so as not to get caught.

Equip the bathroom and toilet rooms with comfortable handrails. It is important to prepare a high chair or armchair and raise the level of the bed. Before surgery, you need to learn how to walk on crutches, learn the rules for performing exercise therapy exercises, in order to immediately begin treatment sessions.

Diagnostics

Before the operation, the specialist clarifies:

• General health and the presence of chronic and acute diseases.
• Blood clotting rate (coagulogram and OAC are prescribed).
• Allergy to anesthesia and medications.
• The severity of damage to the hip joint (diagnosis using X-ray and CT).

Based on the images, a suitable implant design is determined so that it takes root 100% and does not limit the functionality of the joint.

Contraindications

Arthroscopy of the hip joint is not performed during the period of exacerbation of chronic pathology.

In addition, contraindications to performing the manipulation are:

• allergic reactions to anesthesia components;
• a significantly pronounced layer of subcutaneous fat;
• infectious process on the skin, in soft tissues near the joint;
• ankylosis - fusion of the articular ends of articulating bones, in which there is no articular cavity;
• extensive traumatic injury to soft tissue in the pelvic area;
• severe cardiac, renal, liver failure;
• diseases of the respiratory tract (impossibility of endotracheal anesthesia).

Types of hip replacement surgeries

Specialists perform partial or complete joint replacement using an implant. The selection is made based on the following information:

• Presence of chronic diseases.
• Strength of cartilage and bone tissue.
• Age.
• The degree of damage to the joint.

Older people get a partial replacement because they do not put extra stress on the implant. But there is a significant drawback - the service life of the structure is only 5 years and after the expiration of the period, replacement is recommended. A complete replacement is difficult to tolerate, since the operation takes a long time and spinal anesthesia or full anesthesia is used. The trauma to soft tissues is significant, which causes extensive blood loss. But there is a serious advantage - the function of the hip joint is restored by 100%, and the service life of the implant exceeds 15 years even with physical activity.

Prognosis and possible complications

The service life of a properly installed, high-quality hip replacement with a lifestyle of moderate physical activity is 20-25 years (according to the FDA).[3]

Complications associated with implant installation may occur during and after the intervention:

1. Intraoperative complications include fracture of the femoral shaft, fracture of endoprosthetic components, premature polymerization of bone cement, intraoperative blood loss and fat embolism.
2. In the early period after surgery, complications from anesthesia, contracture, hematomas, vein thrombosis, bedsores, and soft tissue suppuration may occur. Sometimes anemia, pneumonia, urinary retention, neurological pathologies, and acute adrenal insufficiency develop. Dislocation of the head of the endoprosthesis can be observed both in the early and late postoperative period.
3. In the long term, there is a risk of loosening and instability of the implant components. Osteolysis of the bone around the prosthesis and Stress-shielding syndrome may progress - redistribution of bone mass with areas of hypertrophy or atrophy of bone tissue. Late complications include fracture of the femur, endoprosthesis stem, joint infection, ossification, migration of the implant cup, and separation of the greater trochanter of the femur.

If you consult a surgeon in a timely manner, many complications can be successfully treated.

Selection of surgical technique

The choice of technology is made based on the following information:

• Age.
• Presence of acute and chronic diseases.
• Strength of cartilage, joints, bones.
• Degree and type of damage.

To access the injured area, a posterior, combined, anterior or anterolateral incision is used. A posterior incision is preferred because it reduces morbidity. Other types are also used, but only for repeated surgery. After access to the desired area, the tissues are moved apart and fixed, the joint is opened, and the damaged tissue is removed. Next, the femoral head and acetabulum are removed if total joint replacement is chosen. After this, the implant is fixed, sutures are applied, drainage is created and restoration begins.

In what cases is endoprosthetics required?

Many injuries, congenital or acquired diseases, as well as age-related degenerative changes in tissue cause pain, impaired movement up to complete immobility and loss of functionality: they do not allow you to stand, bend or straighten a limb, etc. Conservative therapy in such cases is ineffective. Eliminating pain and completely restoring the lost range of motion is only possible by replacing the damaged joint with an endoprosthesis. This becomes especially relevant when the hip and knee joints are affected.

Revision endoprosthetics

Performed if severe complications arise during rehabilitation:

• Broken prosthetic leg.
• Loosening of the joint.
• The appearance of scar-adhesive tissue.
• Penetration of infection and accumulation of pus.

The main difficulty is the lack of bone tissue, since it was removed during the main operation. The expert has to clean the area and re-fix the implant. It is impossible to re-install the prosthesis during sepsis, since the infection quickly enters the organs and penetrates the blood (a complication that is extremely rare).

Anesthesia

Taking into account the amount of work during hip replacement, the patient’s health condition and a number of other points, general, spinal, epidural anesthesia or a combination of the last two can be performed. General is used extremely rarely; almost 90% of patients undergo spinal or epidural anesthesia in combination with intravenous sedation to reduce stress.

Both methods are not accompanied by a loss of consciousness of the patient. In spinal spinal surgery, an anesthetic is injected into the subarachnoid space of the spine through a thin needle into the cerebrospinal fluid, which blocks the transmission of nerve impulses. With epidural anesthesia is given through a thin catheter into the epidural space of the spinal column, which also leads to loss of pain sensitivity in the required area.

After anesthesia, a person does not feel the lower limbs for 4-8 hours, so he will be able to stand up only after sensation in the legs is restored. The patient has a urinary catheter installed because he cannot control his bladder for a certain period of time. As soon as sensitivity returns, it is removed. To reduce blood loss and improve visualization of the surgical area, the anesthesiologist maintains low pressure during the operation, which is called controlled hypotension.

How is hip replacement performed at the CELT clinic?

• Painless
  The operation is performed under general anesthesia or with epidural anesthesia (the type of anesthesia is chosen by the patient together with the anesthesiologist), in any case the operation is painless for the patient.
• Low-traumatic
  The operation is performed through a lateral external incision 10-15 cm long in the upper part of the thigh. The head and neck of the femur, as well as cartilage from the surface of the acetabulum of the pelvic bone, are removed in stages, followed by replacement with prosthetic components.
• Effective and safe
  There are many different models of endoprostheses: cemented, cementless, with different options for the femoral part, heads and cups of the joint (ceramics, plastic, metals). The choice of endoprosthesis is determined by the patient’s age, his activity in everyday life, and the specific clinical situation.

Thanks to extensive experience, modern equipment and surgical instruments, orthopedic traumatologists at the CELT clinic successfully perform such operations completely safely for the patient.

Why is research needed?

During hip arthroscopy, the doctor conducts a thorough examination of all its structures. The main goal is to identify lesions. Manipulation allows you to detect even minor pathological changes. The doctor examines:

• articular cavity (there must be a sufficient amount of synovial fluid in the cavity);
• femoral head;
• acetabulum;
• cartilage tissue;
• ·ligamentous apparatus of the joint.

Multiple access to the hip joint allows for a thorough examination of the structures from all sides.

Arthroscopy also makes it possible to carry out therapeutic procedures:

• remove bone fragments or a foreign body that has entered the joint cavity;
• excise pathologically altered cartilage tissue;
• remove adhesions;
• compare damaged areas of bone;
• restore the integrity of the ligamentous apparatus.

Why do they trust us and choose the CELT clinic?

• An experienced doctor, Professor Vladimir Sergeevich Zubikov, performs endoprosthetics operations. For more than 30 years, he has been treating joint pathologies, including cases complicated by suppuration, instability, and fracture of the endoprosthesis.
• Thanks to the extensive experience and high quality of work of the anesthesiological team, we do not deny the right to surgery to very elderly patients; this is a feature of our clinic.
• Our selection of endoprostheses is individual; we do not rely on “what is available...”.
• The CELT clinic is a multidisciplinary institution; we have the opportunity to consult a patient with a specialist of almost any profile if necessary, carry out diagnostics using various methods, treat complications and concomitant pathologies.

results

With a high-quality operation, the correct selection of a prosthesis, and the patient’s conscientious implementation of all recommendations during the rehabilitation period, a normal standard of living and physical activity are restored. The designs of the latest models can last 10-15 years; after failure, a repeated replacement operation is required. To ensure that the prosthesis lasts as long as possible, you must adhere to the following recommendations:

• exclude deep bends and squats;
• monitor your posture in any position;
• engage in therapeutic exercises even after full recovery;
• do not give up crutches before the recommended time;
• walk more, but at the same time avoid overwork;
• avoid too strenuous physical activity.

Patients are not recommended to engage in intense sports that involve lifting weights, sudden jerks of the body, swinging legs, or jumping. It is better to prefer swimming, race walking and similar sports.

In recent decades, endoprostheses, the instruments for their installation, and the materials used have undergone significant changes, and their service life has also increased. Every year their quality only improves, which gives hope for the possibility of one-time prosthetics without the need for replacement throughout life.

Reviews of doctors providing the service - Hip replacement

Several months ago, Igor Grigorievich performed arthroscopic surgery on my acromioclavicular ligament.
Installed dogbone implant. Everything is great, I lead an active lifestyle and play sports. I already forgot which side it was from! Read full review Alexey

25.11.2019

Dear employees, dear management of the Endosurgery and Lithotripsy Center, good afternoon! 2 months ago I had hip replacement surgery performed by specialists from the Center: Vladimir Sergeevich Zubikov - orthopedic traumatologist, doctor of medical sciences, doctor of the highest category, ... Read full review

Pershin Vladimir Alekseevich

20.08.2018

Arthroscopy technique

To perform intra-articular manipulations, a special device is used - an arthroscope. It is inserted through a micro-incision into the cavity of the hip joint. Based on its operating principle, it belongs to endoscopic medical equipment. The arthroscope is inserted through a tube, which protects it from damage. A high-resolution video camera, a light source and a fiber-optic cable are attached to the main part of the device. These components are responsible for high-quality image transmission to monitors. The arthroscope also contains:

• channels for introducing various surgical instruments;
• an irrigation and aspiration system that allows the supply and removal of fluid from the joint cavity during arthroscopic operations.

When performing arthroscopy of the hip joint, aseptic conditions are required. Therefore, the manipulation is performed in the operating room. The procedure is performed under general anesthesia, which is most often administered endotracheally.

The position of the patient's body during manipulation is lying on the healthy side. This provides access to the affected hip joint. With the help of special stretchers, the joint is given a position in which the joint space is maximum. The entire preparatory process is controlled by radiography. Achieving an optimal position of the hip joint makes its cavity completely accessible for inspection during arthroscopy.

Before the manipulation, the doctor marks the boundaries of the articulation, the projection of the great vessels and the location of large nerve trunks on the patient’s skin. After which the safest access points to the joint cavity are selected.

Algorithm for hip arthroscopy:

1. Adrenaline, diluted to the required concentration with saline, is injected into the joint cavity. This allows you to increase the joint space to its maximum size.

2. Through a skin incision, a trocar is inserted into the cavity of the hip joint - a surgical instrument, through the tube of which it is used for safe insertion of the arthroscope. As a rule, the doctor makes 3 full accesses to the joint, which makes it possible to examine the condition of the articular structures in three planes.

At the end of both diagnostic and therapeutic arthroscopy, an antiseptic solution is injected into the joint cavity to prevent purulent complications. Anesthetics are used for pain relief. After removing the arthroscopes, the wound is sutured and sterile dressings are applied.

Late stage of rehabilitation

From the moment the patient is discharged from the clinic where the hip replacement surgery was performed, the late stage of rehabilitation begins. You can go through it yourself, but it is better to go to a specialized medical institution and undergo rehabilitation under the supervision of specialists. In this case, you can not only count on the best effect from endoprosthetics, but also on the fastest possible recovery of the body.

With normal completion of the early stage of rehabilitation, starting from the 22nd day, daily walking is indicated. They should be done 3-4 times a day, and each should last about 30 minutes. Gradually, the duration of walks is increased, bringing the total walking time to 4 hours by the 3rd month of recovery.

While walking, you should carefully monitor your posture and gait, and avoid habitual adaptive postures and movements.

You can stop using crutches approximately 1.5-2 months after surgery. They are replaced with a cane, with which you should walk for another 1-2 weeks. But all these changes in the physical regime are carried out with the permission of the attending physician. However, older patients may take longer to recover from arthroplasty and may require support devices longer. The timing of abandonment of crutches and canes also depends on the method of fixation of the endoprosthesis used. When using cement technology, it is possible to give full weight-bearing to the operated leg after 1-1.5 months. If a cementless technique was chosen, then the joint can be fully loaded no earlier than after 2 months.

At this time, you can already return to driving a car. But patients must learn to drive correctly: first sit in the seat and only then pull up their legs.

At the later stage of rehabilitation, exercise therapy classes are also continued. At this time, physical therapy classes are increasingly expanding due to the introduction of new and more diverse types of movement. But all this is carried out only with the permission of the attending physician. Often, patients at this stage are recommended to perform leg extension exercises using a rubber band, as well as perform a number of others that actively involve the hip joint in the work.

In the later stages of rehabilitation, sanatorium-resort treatment is indicated.

Endoprosthetics is always a disability or maybe not?

The opinion that endoprosthetics is a disabling intervention is partly justified. This is due to the fact that the hip joint is very complex and at the same time experiences a large load. However, first of all, answering the question “does disability occur after hip replacement,” I would like to remind you that replacing a joint with a prosthesis is always an extreme measure, which is resorted to when other ways to return the patient to the ability to move normally and lead a full life have been exhausted . That is, in fact, the patient in this case is already disabled, regardless of whether this is legally formalized or not. And the task of the operation is precisely to lead the patient to the return of mobility.

For endoprostheses, the chemical composition of all its components is extremely important. After all, the implanted artificial joint will have to serve a person for many years. Today there are many different models of endoprostheses: cemented, cementless, with different options for joint heads and cups (ceramics, plastic, metal). Only an experienced orthopedic surgeon can decide which prosthesis is suitable for the patient.

Endoprosthetics is an extremely complex and high-tech operation that lasts about two hours and requires the highest professionalism from the doctor. The surgeon uses about 80 different instruments during the operation. With cemented fixation, the prosthesis is glued to the patient’s bone, with cementless fixation, the bone will grow into it over time. The period of rehabilitation of patients after endoprosthetics is especially important. It should only be carried out under the supervision of experienced physical therapy specialists and physiotherapists. Of course, you will have to walk on crutches for several weeks after the operation. But haste is not appropriate here.

How effective is hip replacement surgery?

Total hip replacement is one of the most clinically and cost-effective medical procedures, with more than 453,000 such procedures performed in the United States in 2010. Between 2000 and 2010, the rate of hip replacement surgery increased by 49%, due in part to advances in hip replacement technology, improved surgical skills, and a growing number of patients requiring hip replacement surgery. The percentage of successful surgical results 10 years after this intervention is 90-95%.

Surgical success rate

According to the American Academy of Orthopedic Surgeons, more than 95% of total hip replacements performed annually in the United States are successful, result in pain relief, and do not require revision surgery. The effectiveness rate of hip replacement 10 years after surgery is 90–95%, and after 20 years – 80–85%. Revision surgery may be required either if the prosthesis is worn or unstable. Implants made from modern materials, produced using computer technology, can have a longer service life - up to 30 years.

Who undergoes hip replacement surgery?

In the USA, the frequency of surgical interventions in patients over the age of 65 years is 48%, and in patients aged 45-64 years – 34%. The most significant factor determining the need for hip replacement is severe arthrosis. However, other conditions such as rheumatoid arthritis (a chronic inflammatory disease that causes stiffness, swelling and pain in the joint area), osteonecrosis (or avascular necrosis - death of bone tissue caused by insufficient blood supply), femoroacetabular impingement syndrome (a condition , caused by an abnormal shape of the bones that form the hip joint), injuries, fractures and bone tumors can lead to destruction of the hip joint and the need for hip replacement. Pain from hip arthritis is usually localized to the groin and buttocks and is the main indication for hip replacement. After endoprosthetics, relief of pain caused by arthritis occurs immediately, and complete relief of postoperative pain usually occurs within a week. In addition to pain relief, hip replacement also leads to a marked increase in range of motion and can significantly improve quality of life. New technologies and developments in surgical techniques have significantly reduced the risks associated with hip replacement.

Rehabilitation as a component of successful treatment

While the success rate of hip replacement surgery is very high, the success of the overall procedure largely determines the postoperative recovery period. The success of hip replacement largely depends on the patient's participation in the rehabilitation process. The importance of this stage of treatment cannot be overestimated!

Rehabilitation after hip replacement begins almost immediately. In the postoperative period, a physiotherapist begins to work with the patient. In the early stages of rehabilitation, the emphasis is on maintaining motor activity in the prosthetic joint and gaining confidence in the patient's ability to move safely.

The most common problem in the postoperative period is hip dislocation. Because the artificial ball and socket joint and acetabulum are typically smaller in size and the muscles become weaker, the head of the prosthesis may become dislodged from the acetabulum in certain hip positions. The most dangerous positions are external and internal rotation and raising the knees to the chest.

What should you expect from a hip replacement?

If hip replacement surgery is successful, the patient does not experience pain, but this does not mean that the hip joint is fully restored. Most patients do not experience pain. However, a number of patients periodically develop pain and a feeling of “foreignness” of the joint. Most will be able to return to their previous level of physical activity, but intense exercise and running are not recommended. Recommended: golfing, walking, lifting extra weights, doubles tennis, dancing, cycling and swimming. More hazardous physical activities such as horseback riding, skiing and water skiing are possible but pose some risk to the joint. A fall can cause a hip dislocation or fracture of the bone surrounding the implant. These types of physical activity are not recommended unless the patient engages in them professionally. When is revision hip surgery required?

Revision surgery involves removal and replacement of the originally installed prosthesis, usually due to the development of complications during primary hip replacement. Revision hip arthroplasty is performed relatively rarely. The most common reasons for revision surgeries are:

• Repeated cases of dislocation of the prosthetic hip joint
• Mechanical reasons (implant wear, instability, breakage)
• Infectious complications

Fortunately, many factors that predispose to the need for revision surgery of a prosthetic joint can be avoided by paying close attention to it and preventing excessive stress on both the implant and the surrounding muscle tissue.

How can I avoid the need for revision surgery?

• Follow your doctor’s recommendations for rehabilitation in the postoperative period;
• Learn and perform rehabilitation physical exercises as directed.
• Develop the joint while avoiding excessive, including axial, loads

Natural wear and tear of the prosthesis usually does not cause pain to the patient. Therefore, it is very important to have your prosthetic hip examined regularly. A simple physical examination and x-ray should be performed within the time frame prescribed by the attending surgeon.

What are the risks of delaying hip replacement surgery?

Only the patient can decide on his own readiness to perform surgery. Doctors and surgeons make recommendations, but the final decision is made by the patient. What happens if the patient decides to tolerate the pain and delay surgery? As in other medical situations, patients should take their surgeon's recommendations seriously. When a surgeon recommends surgery, delaying it carries risks such as further damage to the joint, increased pain, and loss of joint motion. It should also not be overlooked that less invasive surgical techniques, such as superficial hip replacement, will no longer be possible.

If the degree of damage to the joint is not severe, the doctor may first recommend initial conservative therapy. If these measures are ineffective, as well as there are no indications for their implementation, the doctor may recommend performing total hip replacement. What is the intensity of the pain syndrome and how much does it justify the decision to consent to surgical intervention? The patient must decide the answers to these questions independently. There are a number of clinical situations in which the doctor may recommend delaying surgery. However, if the patient's condition worsens and the intensity of the pain syndrome is predicted to increase, delaying surgical intervention carries certain risks.

The greatest risk associated with delaying surgery is further damage to the tissues that make up the joint and progression of the disease. As arthritis progresses, the damaged joint will continue to deteriorate. This, in turn, increases the likelihood of developing pain and joint deformation. In younger patients with hip disease, this risk may be even higher. Over a period of time, in the earlier stages of arthritis in patients with hip disease, surface replacement may be performed, but later this option becomes less likely to be useful.

The risk of delaying surgery is especially high in patients who have become sedentary and unable to perform daily tasks. The inability to play tennis four times a week may not be a reason to undergo hip replacement surgery, but the patient's inability to get out of a chair and go to the bathroom calmly may be. It is important that patients who lead a sedentary lifestyle due to joint damage consult their doctor.

Research indicates that there may be an optimal time to perform hip replacement surgery. For example, the results of surgery in patients whose musculoskeletal condition was better before the procedure are often superior to those of patients whose musculoskeletal condition worsened due to a delay in surgery. In an article published by the University of Toronto*, Fr. In other words, early surgery is usually better than late surgery.

According to Dr. Ian Clark, a researcher and founder of the Peterson Tribology Laboratory, which studies joint replacement at Loma Linda University, most patients delay surgery due to the following perceptual problems:

• fear of the unknown;
• fear of surgery;
• fear of “losing” a body part;
• fear of postoperative pain;
• fear that their condition after surgery may worsen compared to the original.

However, after undergoing hip replacement surgery, most patients express regret that the intervention was not performed earlier. Dr. Clarke points out, "The most common thing I hear from patients is, 'If only I knew then what I know now, I would have done this years ago.'

Why is it so important to obtain the opinion of several specialists when deciding whether to undergo total hip replacement?

When choosing a surgeon to perform hip replacement surgery, a patient should choose from two or even three specialists. Total hip replacement involves a significant amount of time (the recovery period can take up to two months), lifestyle changes and, as a rule, financial costs. Obtaining a second specialist's opinion helps the patient gain a more complete understanding of the disease, possible conservative treatment methods and the specific surgical technique that is most optimal in his case. Revision surgery is sometimes required after hip replacement surgery, but if the patient can find a good surgeon, this may not be necessary.

This important decision in a patient's life requires careful consideration. When preparing for hip replacement surgery, the patient should develop an understanding of possible treatment options. For example, total hip replacement may not be the best choice for younger patients. With superficial hip replacement, more bone tissue is preserved, which makes it possible to delay the need for total hip replacement.

Even if the patient and the surgeon have reached a consensus on the need for total hip arthroplasty, it should still be taken into account that different surgeons may have different ideas about the treatment of the disease in each particular case. Surgeons use different approaches and have different preferences regarding materials for manufacturing implants, selecting the size of prosthetic heads and methods of fixation - cemented or cementless (mediated by the growth of bone tissue into the prosthesis). In addition, some specialists are more willing to accept new technologies and techniques, while others are more conservative in their views. For all these and other reasons, the opinions of several specialists in the field allow the patient to form a better understanding for making a decision regarding the implementation of prosthetics.

The patient should take a list of prepared questions with him to the consultation with potential surgeons. The patient needs to not only “get to know” the doctor, but also inquire about his surgical experience. Surgeons should be comfortable with questions regarding their performance. The patient needs to listen carefully to each specialist before making a choice.

When making an appointment for a consultation, you should keep in mind that in-demand surgeons have a waiting list of up to six months. Therefore, it is better to sign up in advance.

Questions to discuss with a potential surgeon:

• Do you have any specialization/qualification?
• How many similar operations have you performed in the past and how many do you perform per year? (Studies have shown that surgeons who perform a high volume of procedures, with well-equipped operating rooms, have lower complication rates. “High volume” is considered to be more than 200 total hip replacements per year per surgeon. New technologies such as computer navigation and robotic surgery allows some first-class surgeons to perform up to 400-600 prosthetic operations annually).
• What type of implant will be used? What is its service life? What else do I need to know about him?
• How long does it take to install this type of prosthesis and what are the reasons for choosing it?
• What is the frequency of infectious complications in your patients? (0.5% or less is a good indicator)
• What are the existing risks and the likelihood of their occurrence?
• What is the frequency of early complications - dislocations, wound infections in your patients?
• What is the frequency of late complications - infections, instability and breakage of the prosthesis, noise produced by the prosthesis, non-localized pain, the need for additional manipulations in your patients?
• What type of anesthesia will be used? What are its risks?
• What surgical approach do you prefer for prosthetics (posterior, lateral/anterolateral, direct anterior, minimally invasive techniques with or without the use of robotics)? Why?
• How long will I be in the hospital?
• How long does the recovery process take?
• Will I experience severe pain? If yes, what pain relief methods can you offer me?
• Will there be a need for physical therapy? For how long?
• Will restrictions on daily activities be recommended postoperatively? For how long?
• What positive changes should I expect from the operation?

How does the consultation work?

During the consultation, the doctor conducts an examination, interviews the patient, determines the cause of the pathology and the presence of indications and contraindications for its elimination. If femoral neck joint replacement

is, an examination is ordered and the appropriate type of prosthesis is determined. The examination uses an x-ray, which allows you to assess the condition of the bones and determine the degree of wear of the joint. The patient is informed about possible complications and consequences of future intervention. Possible complications of the operation include:

• Infection.
• Blood loss.
• Pneumonia.
• Dislocation of the prosthesis.
• Blockage of blood vessels with blood clots.