Hip orthoses are special orthopedic devices; they are used to unload the joint during diseases and injuries. When using an orthosis, the joint stops collapsing during movement, the pain subsides and recovery is much faster.
The hip orthosis must perform a good fixation function. The more serious the pathology, the stronger the fixation should be. Therefore, only a specialist should select a bandage after examination, then the treatment will be as effective as possible. The Yusupov Hospital employs highly qualified specialists who will conduct a high-quality examination and prescribe appropriate treatment.
Types of endoprostheses
The difference between cemented and cementless components of a hip joint endoprosthesis is the structure. The structure of the cement stem of the product is smooth, while the cementless stem is rough. The production of cups for cemented prostheses uses high molecular weight cross-linked polyethylene. Metal alloys are used to make cementless cups.
The principle of fixation is the main difference between these two types of prostheses. Cementless models of endoprostheses are covered with a porous or hydroxyapatite coating. They are fixed in place using a “tight fit” method, which allows the bone to grow into the implant. Fixation of the cement endoprosthesis is carried out using special polymer cement. Polymethyl methacrylate is used to make it.
When endoprosthetics of the hip joint requires fixation of two components of the implant: the stem and the cup. Both elements can be either cemented or cementless. If the endoprosthesis consists of cemented and cementless elements at the same time, then it belongs to a hybrid or reverse-hybrid model.
Cementless fixation of the endoprosthesis
A porous coating or specially made grooves in the surface of the components of this category of implants serve for the growth of bone tissue into the structure. The stem of such an artificial joint can be coated with titanium. After rehabilitation, this fusion of bone and prosthesis ensures the strength of the connection. The elements are fixed using the press-fit method. It is performed by driving the prosthesis into the bone. This method is excellent for young people, since at their age regeneration occurs quickly and the body quickly adapts to a foreign body. Considering the long period of use of artificial joints, the patient will undergo a second operation after 20–25 years. Replacing a cementless prosthesis is easier.
Cemented endoprosthesis
These products are used more often during surgery to treat elderly patients. The reason for this is the decrease in bone density and strength with increasing age. The loose structure of the bone cannot guarantee the strength of the connection during ingrowth, so the implant is fixed with cement.
A type of polymer is used as a fixing material. The stem of the cement prosthesis is polished to create a smooth surface. The stem does not come into contact with the bone; its end is immersed in the cement mass. The smooth surface allows to minimize the pressure on the cement during movement, so the cement mass is able to hold the endoprosthesis for a long time.
Coxarthrosis
Arthritis
5355 January 15
IMPORTANT!
The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Coxarthrosis: causes, symptoms, diagnosis and treatment methods.
Definition
Coxarthrosis is the most common and severe form of osteoarthritis of the hip joints, which usually leads to progressive dysfunction of the joint up to its complete loss. In the general structure of joint pathology, coxarthrosis consistently ranks second after gonarthrosis in terms of incidence and first in terms of temporary and permanent disability.
Coxarthrosis can be unilateral or bilateral and is characterized by degradation of cartilage tissue, bone remodeling, formation of osteophytes (pathological growths), inflammation, etc.
Thus, coxarthrosis is considered as an organ disease of the entire joint, in which the process involves cartilage, subchondral bone, synovial membrane, ligaments, capsule, and muscles. There are primary (idiopathic) coxarthrosis and secondary, which occurs against the background of various diseases. Primary coxarthrosis is one of the most common degenerative pathologies of the hip joint. In some patients, it accompanies the natural aging process of the body.
Causes of coxarthrosis
Risk factors for coxarthrosis are divided into genetic, acquired (non-genetic) and environmental. The development of coxarthrosis is regarded as a consequence of the influence of various biological and mechanical factors, such as degenerative-dystrophic diseases of the hip joint, congenital hip dislocation, aseptic necrosis of the femoral head, inflammatory process, trauma (bruise, dislocation, fracture, microtrauma), metabolic disorders, genetic or hereditary predisposition, age, vascular abnormalities, excess weight and unfavorable working conditions.
Although in coxarthrosis all joint tissues are involved in the pathological process, the leading signs of the disease are degeneration and destruction of articular cartilage.
The inflammatory process affects almost all structures of the joint with the formation of chondritis, synovitis and osteitis.
Classification of the disease The most common and widely used classification is considered to be according to N.S.
Kosinskaya (1961): Stage I – slight restriction of movements, slight, indistinct, uneven narrowing of the joint space, slight sharpening of the edges of the articular surfaces (initial osteophytes).
Stage II – limited mobility in the joint, rough crunching noise during movements, moderate amyotrophy, pronounced narrowing of the joint space by 2-3 times compared to the norm, significant osteophytes, subchondral osteosclerosis and cystic clearing in the epiphyses.
Stage III – joint deformation, stiffness, absence of joint space, deformation and hardening of the articular surfaces of the epiphyses, extensive osteophytes, articular “mice”, subchondral cysts.
There is also a four-stage classification by Kellgren and Lawrence:
Stage I - minor marginal osteophytes are detected without changing the height of the joint space.
Stage II - significant marginal osteophytes are determined without changing the height of the joint space.
Stage III - significant marginal osteophytes are detected with a moderate decrease in the height of the joint space.
Stage IV - significant marginal osteophytes, subchondral osteosclerosis, and significant narrowing of the height of the joint space are determined.
Tonnis classification:
Stage I - sclerosis of the head and acetabulum increases, a slight narrowing of the joint space and a slight sharpening of the edges of the joint space.
Stage II - small cysts in the head or acetabulum, moderate narrowing of the joint space and moderate loss of sphericity of the femoral head.
Stage III - large cysts in the head or acetabulum, the joint space is absent or significantly narrowed, severe deformation of the femoral head, signs of necrosis.
Symptoms of coxarthrosis
The clinical picture of the disease corresponds to internal changes in the tissues of the joint. Symptoms increase gradually, and in the first stages the patient does not pay due attention to them. This is dangerous, because it is at the beginning of the degenerative process that treatment brings greater effect.
The first clinical symptoms (pain, limited range of motion) appear in the absence of radiological changes in the joint; they are caused by muscle spasm. Pain in the hip joint in the case of primary coxarthrosis occurs with load or movement and intensifies after walking. With coxarthrosis, pain at the onset of the disease is often localized not in the area of the affected joint, but in the knee joint, along the outer surface of the thigh, buttock, and in the lumbar region, which makes diagnosis difficult. The limitation of range of motion in the joint gradually increases, and a number of patients experience a symptom of “blockade” of the joint. In such patients, limited movements in the joint, pain during internal rotation in a bent position, and pain on palpation of the groin area lateral to the site of pulsation of the femoral artery are determined.
With a long course of the disease, atrophy of the thigh and gluteal muscles appears.
The limb assumes a forced position - slight flexion at the hip joint with impaired rotation and abduction, compensatory lumbar lordosis, pelvic tilt towards the affected joint and scoliosis occur. All this can cause back pain.
Diagnosis of coxarthrosis
To make a diagnosis of coxarthrosis, it is necessary to have pain in the hip joint and at least two of the following three signs:
- ESR <20 mm/h;
Advantages and disadvantages
The table below shows the advantages and disadvantages of cementless and cemented hip replacements.
| Type of artificial joint | pros | Minuses |
| Cement | It is inexpensive, distributes the load perfectly; less risk of bone fracture; good for hip bone deformities; An antibiotic can be added to the cement to prevent inflammatory processes | The friction pair is always without options, only metal/polyethylene; complicates the operation of revision osteosynthesis |
| Cementless | Allows you to select the material for manufacturing the friction pair; the replacement operation is easier; service life is longer due to bone ingrowth into the structure | Costs more than cement; distributes the load worse; risk of bone fracture during surgery; risk of under-submerging the cup; the possibility of an infectious inflammatory process with concomitant diseases (arthritis, diabetes, anemia, etc.) |
Wearing a hip orthosis
The hip joint always experiences quite a lot of stress; if it is injured, it will be quite difficult to treat. This may be a mechanical injury or an inflammatory degenerative process, which is most common in older people.
In such situations, treatment usually begins with medications, and the doctor may also prescribe surgery if the fracture or joint is displaced. The Yusupov Hospital uses comprehensive and timely treatment, which is aimed at restoring and healing the pelvis so that problems do not arise later.
Hip orthoses help prevent re-injury while the muscles are still weakened. This is especially true for older people, because the hip joint can recover quite poorly. This is mainly associated with poor circulation.
A hip orthosis is used to fix it in a certain position. The orthosis is considered a fairly new device that has begun to replace the plaster cast. It can be removed, which is more convenient for patients, and in addition, its degree of rigidity is selected individually depending on the pathology.
If the patient had serious injuries, if it was necessary to fix the hip joint as much as possible, previously a plaster cast was used, which did not allow the person to move. Today, it is replaced by a rigid orthosis, which perfectly fixes the desired joint and at the same time gives the person the opportunity to walk, which is a big plus, since blood circulation improves during movement and recovery occurs faster. Soft orthoses can be used for inflammation; they partially fix the pelvis and at the same time do not allow it to collapse.
Which hip replacement is best?
Today, recommendations for installing a cementless endoprosthesis as opposed to a cemented one can be obtained even from surgeons who are professionally involved in osteosynthesis. In fact, both types of endoprostheses have their own indications and contraindications for use. In some cases, one type should be installed, in other cases, another type should be preferred. The surgeon’s categorical statement about the indisputable advantage of a cementless implant indicates his low professional qualifications or cunning.
Both methods represent two schools of osteosynthesis. The cement method is more often used in Europe, while the cementless method is used mainly in the USA. About 10–15 years ago, active mixing of methods from different schools began, and then they compared both methods.
Indications for wearing
In case of uterine prolapse, a bandage is prescribed by a gynecologist. Self-medication and self-prescription of this method are strictly contraindicated.
When making a decision, the doctor is based on a complex of various nuances that remain inaccessible to ordinary women.
When the uterus prolapses, a support belt is prescribed if:
- The opening of the cervical canal moves closer to the vaginal opening, but the cervix does not yet appear outward.
- The uterine cavity is lowered and part of the cervix of the reproductive organ is visible from the vaginal ring, including in a state of calm.
- Recurrence of the problem after treatment with a conservative or radical method.
- Surgery is contraindicated due to age restrictions and other contraindications.
- The elasticity of muscle tissue is impaired after a difficult birth.
- The gestational age has passed its time equator.
- Several children are born.
- The period after surgery occurs.
- The pelvic floor muscles are subject to increased stress.
Often, a bandage is used as a temporary measure or to provide symptomatic assistance. Its advantages include:
- Availability of use anywhere.
- Eliminate symptoms as soon as possible.
- Low price.
- Wide range of sizes and types.
- Ease of use.
Fixing panties have one important drawback. They do not have a therapeutic effect, but only reduce the load on the pelvis, thereby easing the woman’s general condition.
Effect of use
Bandages, orthoses, splints play an important role in the treatment of complex pathology - femoral neck fracture. With their help, it is possible to solve a number of therapeutic problems:
- removing the load from the injured joint,
- the ability to regulate traffic intensity,
- providing compression support for muscles,
- prevention of re-injuries,
- significant reduction in pain.
In this case, the choice of a rigid model with or without hinges will be the optimal solution after the operation or in the initial stage, when the primary goal is reliable fixation of the joints for proper fusion.
Soft bandages will become an indispensable support during the recovery and rehabilitation periods, helping to reduce pain, distribute the load, and quickly return the necessary mobility to injured joints. The main guarantee of the effective use of a bandage for a femoral neck fracture remains the correct choice of product, based solely on the recommendations of a specialist with mandatory consideration of the patient’s individual parameters.
How to care
Proper care of the bandage is the key to its long service life. The packaging of any fixation belt contains information on proper care of it. The washing rules are affected by the material used in the production of the device.
The following requirements are common to most manufacturers:
- The water temperature for washing is not higher than 40 degrees.
- Cleaning is done using delicate detergents.
- Boiling and bleaching the bandage is prohibited.
- You can soak the device for no more than 30 minutes.
- Belt wringing is prohibited.
- Drying is allowed on a regular radiator or drying rack.
An automatic machine is not suitable for washing bandages. In it they stretch, the fastening elements are damaged. Ironing and dry cleaning are prohibited.
If all the rules for proper care of the device are followed, the service life of the fixing belt is at least five years. If the rules are violated, the elasticity of the material will be lost in the first year of operation.
Possible complications
Complications after replacing the hip joint with an implant are quite rare.
Sometimes an infectious process develops with the accumulation of purulent exudate due to the penetration of streptococci, staphylococci, pathogenic fungi, and activation of herpes viruses into the postoperative wound. There may be a blockage of a blood vessel by a thrombus, impairing blood circulation in a certain area of the leg. To prevent such complications, patients use antiseptics when treating sutures; antibiotics and anticoagulants are taken orally.
To prevent thrombosis, you will need to take blood thinning medications for a month after surgery.
Patient reviews
Endoprosthesis replacement is often the only way to get rid of pain that occurs during the day and night, and gets worse when walking. Now patients indulge in long walks in the fresh air, travel, and gardening.
The only restrictions are those sports and movements that involve forceful loads on the operated leg. Due to long-term exercise therapy and gymnastics, not only the physical but also the psychological state of former patients is normalized. Their ligaments and muscles become stronger, and as a result of improved blood circulation, many chronic diseases recede.
Features of endoprosthetics
In case of severe damage to the hip joint (HJ) by inflammatory or degenerative pathology, conservative methods are ineffective. A person gradually loses the ability to move independently. And it is impossible to get rid of pain for a long time even with the help of potent analgesics. In such cases, patients are indicated for endoprosthetics - replacement of the destroyed hip joint with an implant.
At the stage of preoperative preparation, the patient takes medications prescribed by the surgeon and does physical therapy and gymnastics. By strengthening muscles and replenishing vitamins and microelements, postoperative complications can be avoided. The rehabilitation doctor teaches the patient in advance how to walk on crutches, rise from sitting and lying positions, and deep diaphragmatic breathing skills.
The operation does not last long, and a long rehabilitation period begins immediately after it. The patient constantly exercises the operated leg, walks a lot to form the lost correct motor stereotypes. After about 3-4 months, the functional activity of the hip joint and leg is completely restored.
What happens during surgery
The initial stage of endoprosthetics is pain relief. Epidural anesthesia and general anesthesia are used. For elderly patients suffering from chronic pathologies, the first method is preferable. Under epidural anesthesia, a person is fully conscious but does not feel any pain. He hears the tapping of hammers, the sound of a drill, and the conversations of surgeons installing an endoprosthesis.
After accessing the surgical field, the doctor opens the joint capsule, brings out the head of the femur and performs its resection. After modeling the bone, the surgeon processes the acetabulum, removing any remaining cartilage. At the final stage of the operation, the implant is fixed, sutured, and active suction drainage is installed.
Diagnostics
Effective treatment of the hip joint first begins with an accurate diagnosis, since the symptoms of pain and dysfunction of the hip joint can hide a number of diseases - arthrosis, aseptic necrosis, muscle contracture of the joint, synovitis, etc.
To make a diagnosis, our specialists first fully examine the patient, identify all complaints and features of the course of the disease, study previous treatment experience, and available research results. If there is insufficient information, a rational further examination is prescribed, among which we attach the most important importance to MRI diagnostics, since it allows you to visually assess the condition of all tissues of the joint - cartilage, bone, muscle-tendon, and will reveal ligament damage and the presence of inflammatory fluid.
To clarify the diagnosis, other examinations may also be necessary:
- CT scan;;
- Radiography;
- Ultrasound;
- Blood test (for rheumatological process, gout).
Such diagnostic studies make it possible to make a reliable diagnosis and select appropriate treatment for the hip joint. If you notice the symptoms described above, you should make an appointment with a doctor.
How to wear it correctly
The vast majority of jockstraps are made in the form of panties. Fixation occurs on the sides and on the perineum. The fixation belt must be worn strictly in accordance with the doctor’s recommendation. It requires washing periodically.
Various manufacturers provide their own tips for wearing the system correctly. Some people welcome wearing a bandage over underwear, others, on the contrary, under it. If worn under underwear, the risk of irritation, including allergic ones, in the perineal area increases. In addition, this method of wearing is unhygienic.
Uterine prolapse involves wearing a fixation system from the moment you wake up. The optimal body position at the time of dressing is lying down. In this position, the pelvic organs are located as close as possible to their natural position. The retainer is put on in the same way as putting on panties and then fixed. First, using buttons or Velcro, tighten the sides tightly. Finally, fixation occurs on the perineum. It is dangerous to tighten the elastic bands too much, as this can lead to poor circulation in the pelvis. After the final fixation of the bandage, you can begin your daily life.
Before going to bed, you must remove the device while lying down. An exception to this rule may be for women with a certain stage of uterine prolapse.
During a visit to the pool, the fixing belt is worn under the swimsuit. Any physical activity without using a bandage is prohibited. During a visit to the toilet, the device is removed.