When is Disability Statutory for Hip Replacement?

Some patients mistakenly believe that if a hip replacement is performed, they are disabled anyway. But the operation is carried out in order to, by installing an endoprosthesis at the site of a destroyed articular joint, enable a person to move normally and live a full life, so there is no disability with successful prosthetics.

The reason for recognizing a person as disabled is functional impairments that arise after surgery or due to rejection of an implanted implant.

What is the hip joint

The connection between the pelvic bone and the femur is called the hip joint (HJ). The structure of the joint provides support and mobility during movement. The anatomical structure includes:

• spherical head of the tibia, covered with smooth articular tissue;
• acetabulum (formed by the fusion of 3 pelvic bones), lined with smooth hyaline cartilage;
• joint capsule (a capsule of connective tissue covering the cavity and head of the bone), filled with synovial fluid.

Smooth articular cartilage ensures smooth gliding of bone surfaces during movement, and synovial fluid helps reduce friction between the head of the tibia and the acetabulum.

The hip joint is surrounded by powerful ligaments that provide support during movement and prevent the occurrence of anatomical disorders (dislocations).

The muscle groups located around the hip joint allow movement in different planes:

• internal and external rotation of the hip;
• abduction of the lower limb forward, sideways and backward;
• rotation in the joint;
• body bends.

The structure of the hip joint allows it to withstand heavy loads and ensure mobility of the joint when walking. Organic damage to one or more joint elements is accompanied by functional disorders.

Disability after joint replacement - is it allowed or not?

Deforming osteoarthritis (DOA), which develops due to injury, congenital dysplastic or inflammatory disease, can lead to a serious deterioration in all life activities.

This manifests itself in constant, oppressive pain, the inability to move normally and do the same work. Often deforming arthrosis is the cause of disability. One of the treatment methods for DOA is endoprosthetics.

Many people believe that knee or hip replacement automatically gives you disability . Is it so?

Disability with DOA and after endoprosthetics

There are a lot of indignant letters on medical forums on the Internet, with approximately the following content:

My mother, a nurse at City Hospital No. 2, had knee replacement surgery a year ago. Since then, she has been tormented by constant pain, especially her leg aching before the weather changes. She can't bend her knee like she used to, and she can't run. We submitted documents to the ITU, but after the operation they didn’t give her any group... Why?..

To understand this, let’s look at the principle by which disability is generally given for diseases of the musculoskeletal system.

The basis for assigning a disability group may be:

• Deforming arthrosis of both hip or knee joints is not lower than the second stage of arthrosis and moderate degree of joint dysfunction
• DOA of one or more joints (hip, knee, ankle, shoulder, elbow, wrist) in stage III, with ankylosis or shortening of the limb
• Bilateral endoprosthetics, leading to severe disorders

Thus, endoprosthetics surgery itself is not a reason for disability. On the contrary, surgery can be recommended in the late stage of DOA as a method of treating arthrosis and the possibility of removing a number of limitations in life activity (LLD)

A person agrees to an operation, not wanting to become disabled, but on the contrary, wanting to avoid disability.

Another thing is when the joint replacement was unsuccessful for some reason:

• The quality of the prosthesis is low
• The surgeon did not perform computer navigation and unsuccessfully selected the geometric dimensions of the prosthesis
• After the operation, the patient did not undergo rehabilitation or did not undergo it as it should have been

Referral to MSE after endoprosthetics is given in the event of moderate and severe musculoskeletal disorders that lead to limitation of the patient’s life activity (LW)

Let's consider how the degree of musculoskeletal functions is determined and by what criteria the respiratory function is assessed in MSE.

Medical and social examination for deforming arthrosis

Post-traumatic arthrosis is considered the most unfavorable in its course, since it differs:

• The most pronounced dysfunctions (contractures, limitation of movements, shortening of the legs, muscle atrophy)
• Increased frequency of exacerbations
• The rate of disease progression

To conduct MSE, the following criteria for assessing the patient’s condition are required:

1. X-ray diagnostics according to Kosinskaya
2. Functional diagnostics
3. Determination of the degree of statodynamic function (SDF)
4. Determination of the degree of moderation of development of DOA:
   How quickly does the disease progress?
5. How often do exacerbations occur?
6. What complications does the disease cause?

X-ray diagnostics for MSE

Diagnostics during medical and social examination differs from the usual diagnostics used in modern medical practice:

• Thus, the degrees of arthrosis in medical orthopedics based on X-rays are today determined according to the Leuquesne classification - it distinguishes four degrees of arthrosis
• With MSE, the degrees of arthrosis are determined only according to the Kosinskaya classification (three degrees)

• The third degree according to Leuquesne may correspond to the second according to Kosinskaya, which is why controversial situations may arise.
• DOA degrees according to Kosinskaya
• First degree DOA:

• Slight limitation of movement
• Weak and uneven narrowing of the interarticular gap
• Initial osteophytes

Second degree DOA

• Restriction of joint movement in certain directions
• The appearance of a rough crunch when moving
• Narrowing of the gap by two to three times compared to the norm
• Moderate muscle atrophy
• The appearance of large osteophytes
• Signs of osteosclerosis and cystic cavities in the epiphysis of the subchondral bone

Third degree DOA

• Large joint deformations and hardening of bone surfaces
• Sharp limitation of mobility with preservation of rocking movements ranging from 5 to 7˚
• Large osteophytes over the entire surface of the joint
• Closing the joint gap
• Fragments of cartilage in the synovial cavity of the joint (articular mice)
• Subchondral brushes

With complete fusion, it is not DOA that is diagnosed, but ankylosis, which is informally considered the fourth stage of arthrosis

In what cases is joint replacement performed?

Prosthetics are performed when, due to disease or injury, the joint is severely damaged and the function of the hip joint cannot be restored using conservative methods. Indications for surgery are:

• necrotic changes in hyaline cartilage;
• severe limitation of mobility of the hip joint;
• late stages of coxoarthrosis;
• fracture of the femoral head or neck;
• malignant neoplasms in the bone or cartilage of the joint.

Installation of an endoprosthesis allows a person to live a full life without pain after surgery.

When is endoprosthetics necessary?

Deforming osteoarthritis of the hip joint can develop in different ways:

1. Quite a long time and imperceptibly - this happens due to the inflammatory process and genetic predisposition.
2. Quickly, like after an injury.

In any case, endoprosthetics can restore joint function when conservative methods do not bring the desired result.

Hip replacement is necessary if the patient has the following signs of the disease:

• structural changes;
• violation of joint functions;
• deforming osteoarthritis on both legs;
• severe pain with the slightest movement of the limb.

In case of congenital dysplasia of the 3rd degree and in case of a femoral neck fracture, endoprosthetics may also be recommended.

Types of hip joint replacement

The type of endoprosthetics performed depends on the nature of the pathological process and the condition of the patient’s body.

Total view

A frequently used method. All parts of the affected joint are removed, and a prosthesis is installed in their place.

Total endoprosthetics are considered more durable and less likely to cause complications. Patients up to 80 years old can replace a destroyed hip joint with a prosthesis.

Surface replacement

The head of the femur bone is not removed. Damaged areas of cartilage are excised, and the head is covered with a special metal cap, which ensures the bone glides during movement.

Surface prosthetics are less traumatic for the patient. It is carried out when the pathological process affects only cartilage tissue.

Single pole view

The operation is performed when the head of the femur needs to be replaced. The implant is inserted into the acetabulum and comes into contact with the cartilage.

Important! Prosthetics are only done for older people who lead a sedentary lifestyle. With great physical activity, the artificial surface of the prosthesis can lead to abrasion of the hyaline cartilage.

Bipolar technology

The implanted prosthesis has a head with a double movement unit. Installation of a bipolar structure reduces the load on the cartilage and allows the person to lead an active lifestyle after surgery.

Progress of hip replacement

The method of surgical intervention and type of endoprosthetics are selected individually for each patient. The operation consists of several stages:

1. Preparatory. The patient is given anesthesia and the surgical field is treated with skin antiseptics.
2. Exposing the joint. The surgeon makes an incision along the intertrochanteric line with an instrument (scalpel or coagulator), exposing the articular bones.
3. Creating a channel. At an angle in the neck area, the head is separated from the bone and removed. A cavity is formed in the bone element using a reaming.
4. Installation of the head implant. A wedge-shaped leg is inserted into the prepared canal and a spherical endoprosthesis is attached to it.
5. Acetabular prosthetics. Using an instrument, the hyaline cartilage is removed from the cavity and a metal prosthetic cup is installed, and then a polyethylene liner is placed in the container.
6. Reduction of the joint. The metal element of the thigh is inserted into the cup, after which the ligaments and muscles cut during the operation are sutured. A drainage is installed in the postoperative wound.

The principle of surgical treatment for all types of prosthetics is almost the same. Joint replacement lasts about 3 hours.

When is endoprosthetics impossible?

Joint replacement is a serious intervention in the human body. You will have to refuse surgery if a person has the following diseases:

1. Diabetes type 1 or 2.
2. Poor blood clotting.
3. Recent stroke or heart attack.
4. Liver failure.
5. Asthma and other bronchopulmonary diseases.
6. Blood poisoning within 5 years before the proposed operation.
7. Oncological diseases.

Complications after surgery

According to medical statistics, complications after endoprosthetics appear in 2% of those operated on. Depending on the time of occurrence of negative consequences, complications are distinguished:

1. Arising during prosthetics. During surgery, bleeding may occur, allergies to the materials used may develop, and breathing and heart function may be impaired.
2. Early postoperative. Wound infection, bleeding, and swelling are common complications. During this period, the first signs of rejection of the implant material may appear (deterioration of healing, severe pain).
3. Late. These include loosening of the installed endorotesis, joint dislocations, limited mobility of the limb, and muscle atrophy.

The cause of complications may be poor quality of implant materials, non-compliance with medical recommendations for rehabilitation, or a surgeon’s error in selecting the size of the prosthesis.

Endoprosthetics

Hip replacement (endoprosthetics)

Endoprosthetics is the replacement of a damaged or worn-out joint with an artificial implant. The operation, depending on the complexity, can last from 1 hour to 2 hours, and it takes the patient from several weeks to 3 months (on average) to fully return the motor functions of the limb. Joint mobility is restored almost completely, pain when walking disappears. Today, in the treatment of articular pathology, hip replacement is the most effective method, of course, when medications, physiotherapeutic or manual means have already been exhausted.

Endoprosthetic surgery

Hip replacement is considered not only a high-tech procedure, but also one that involves the risk of injury, so the patient must undergo a thorough examination and pass all the necessary tests. All factors that increase risks are taken into account by the clinic’s doctors when collecting a detailed medical history.

Hip replacement is also considered one of the most expensive surgical procedures; suffice it to say that the cost of the operation itself starts from 70,000 rubles, and the cost of a prosthesis, for example a hip joint, from 90,000 rubles. And again the question arises, what should a low-income patient who needs such an operation do? The clinic of the Lymphology Research Institute also resolved this issue. Since several years ago the clinic introduced a number of advanced techniques for endoprosthetics of lower extremity joints, proposed and implemented an integrated approach to the treatment and operation of patients with severe forms of diabetes mellitus, nephritis, heart failure, hypothyroidism, this allowed the clinic to enter the federal program for the allocation of quotas to provide free high-tech medical care. Accordingly, in the clinic of the Lymphology Research Institute, endoprosthetics of lower limb joints is performed free of charge, despite the cost of the operation. As of June 25, 2013, the clinic has 80 quotas for hip replacement free of charge for any resident of Novosibirsk and the region who has submitted an application for consideration by the federal commission. The commission works in the clinic of the Research Institute of Lymphology at the following addresses: st. Arbuzova, 6 and st. Galushchaka, 11. Read all the details on applying for help to the clinic in the corresponding section of the “Free Treatment” website.

Rehabilitation after endoprosthetics

The first few days after the operation, the patient is prescribed gymnastics for rehabilitation, which includes exercises for tensing the hip muscles and breathing exercises. You will have to spend some time “learning” to sit down, stand up, walk, and move up the stairs again. The postoperative hospital stay may take up to two weeks; this will be the main rehabilitation period. You must be prepared for the fact that the pain may not go away or may return, but these are just the consequences of intervention in the bone and muscle tissue of the body. During this period, it is important not to regret the operation performed, the loss of “your own, albeit sick” joint, not to be impressed by conversations with “good” neighbors about a possibly unsuccessful operation, etc.

Please be aware that it may take up to 6 months to restore lost functions, depending on the complexity of the surgery.

What is an endoprosthesis?

Modern hip replacements are complex technical products. The prosthesis consists of a stem, head, cup and liner. All parts have their own dimensions and only during the operation can the surgeon finally decide on the choice of the necessary product for each specific patient.

Hip joint prostheses are determined by the type of fixation, by the presence of a cup that is installed in the socket of the hip joint, by the friction unit and the quality of the materials used in these units, namely: metal-polyethylene, ceramics-polyethylene, ceramics-ceramics, metal-metal.

Hip replacement surgery, like replacing a knee joint with a prosthesis, is a complex, high-tech procedure. Therefore, preoperative examination of the patient, selection of an appropriate type of endoprosthesis for each specific case, as well as strict adherence to recommendations after surgery are of great importance.

Hip or knee replacement surgery is sometimes the only form of medical intervention that can solve the problem of a worn out or injured joint, for example:

• formation of false joints and non-union fractures of the femoral head;
• fresh fractures of the femoral neck and acetabulum in patients over 65 years of age;
• rheumatoid arthritis;
• coxarthrosis in the second or third stage;
• arthrosis that occurs with psoriasis;
• aseptic necrosis;
• tumor diseases of the hip joint.

Work ability examination

Disability after hip replacement is not given to everyone. The reason for recognizing a person as disabled is unsuccessful implantation when, due to severe pain or limited mobility of the hip joint, a person cannot fully work.

Passing a medical and social examination

The issue of recognizing a person as disabled is decided by a medical council. The attending physician from the clinic or hospital refers the commission.

X-ray diagnostics

Using an X-ray examination, the degree of limitation of joint mobility is determined using the Kosinskaya scale:

1. Minor. Movement of the limb is slightly limited, the joint space is slightly narrowed.
2. Moderate. The x-ray shows a pronounced narrowing of the gap; when moving, a crunching sound appears in the joint. Muscle atrophy develops.
3. Heavy. The prosthetic joint is deformed, severe pain occurs. The muscles are atrophied.

Kosinskaya assessment is necessary for medical and social experts.

Functional diagnostics

The degree of decrease in the amplitude of leg movement is checked:

1. First. Mobility is limited to 30°.
2. Second. Amplitude reduced by 50°.
3. Third. Possibility of free movement no more than 15°.
4. Fourth. The joint and leg are deformed, the leg remains in a forced position.

Determination of functional abnormalities is carried out in addition to x-ray diagnostics.

Determination of the degree of statodynamic functions

Based on a visual examination and x-ray data, the severity of the abnormalities that have arisen is determined:

1. Small ones. The prosthetic site and leg begin to hurt after a long walk, the pain goes away after rest.
2. Moderate. The patient limps when walking. The hip of the operated leg is smaller in volume than the healthy one.
3. Expressed. The affected limb looks shorter, the pain persists constantly and intensifies when walking.
4. Heavy. The person loses the ability to walk, and severe pain persists.

Important. Passing all types of diagnostics is necessary to recognize a person as disabled. The absence of a conclusion on one of the types of testing will be a reason to send the person for further examination.

Features of establishing disability

We figured out whether hip replacement gives you disability. Yes, it is assigned, but in exceptional cases, and group I is very rarely assigned to anyone - for this there must be very serious indicators of physical limitation (3-4 degrees of severity - complete unsuitability). Basically, they give grade III or II, but for objective reasons confirming a moderate or mild stage of limited viability. Lifelong disability after total hip replacement, even bilateral, is very rare.

• Let us note that the fact of the presence of a joint implant inside the body is not a reason for an indisputable award of disability.
• Painful symptoms alone are not considered as an unconditional basis for establishing a group.
• The severity of impaired mobility functions and the determination of the extent to which impaired biomechanics interferes with work activities in the main profession will be assessed primarily.
• The category, in addition to decompensation of statodynamic functions, will also be influenced by the main direction of the disease and the existing concomitant pathologies in the patient’s epicrisis.
• If the patient has both joints replaced, according to the order of the Ukrainian Ministry of Health, group II is clearly assigned. According to Russian legislative regulations of the health authority, the number of endoprostheses is not a reason for unconditional disability.

If a postoperative injury does not allow a person to enter a normal rhythm of life and go to work, a persistently reduced functionality is observed in the updated department, and it is expected to receive a disability benefit of 2-3 grams. (grade 1-2 severity of violations), for a period of 12 months with subsequent re-registration. During this period, it is necessary to undergo restorative and therapeutic measures in full, and, if necessary, perform revision endoprosthetics.

Regarding whether hip replacement will give you disability in your case, and which group, it is better to consult with your doctor. If you are consistently dependent on aids (crutches, walkers), are unable to stand standing on your feet for more than 2 hours, have a severe limp and do not feel confident when walking, or may not be able to do without assistance at all, etc., consult your a specialist who will provide guidance on the issue of registering disability.

In what cases is disability granted?

Installation of an endoprosthesis is not an indication for assigning disabled status to a person.
In Russia, you can obtain a disability group by identifying indicators of functional limitations. Disability of the second group is immediately given if two implants are installed. Both joints are rarely replaced.

Which group can you count on?

If postoperative complications interfere with a full life and work, the patient is given group III or II for a year. If during this period there is no restoration of the impaired functions, the disability is extended.

During the initial medical and social examination, group I can be given only if persistent disorders that appeared after surgery are identified.

Read also: Procedure for licensing medical activities: how to obtain a license

Grounds for obtaining a disability group

A person can find out whether it is possible to become disabled by contacting a clinic. Recognition as a disabled person is carried out when a decrease in working capacity and/or loss of self-care is detected.

Third disability group

It is given for moderate mobility restrictions that have arisen due to a slight articular deformity.

Second and first group

If there is significant restriction of movement, severe pain and difficulty in independent movement, a person is recognized as disabled and assigned a disability group:

• second, mobility is severely limited, movement is possible only with the help of special devices (crutches, walkers).
• first - there is no ability to walk independently, the person needs the care of third parties.

The group is assigned based on the survey data.

In what cases can they refuse to receive a group?

The ITU evaluates not only the degree of violations that have occurred, but also the nature of a person’s work activity. A patient with moderate functional disorders may be denied recognition as a disabled person if the work is not accompanied by a heavy load on the legs:

• office activities;
• vehicle management;
• coordination of industrial mechanisms.

These types of activities are considered “light labor” and do not place much stress on the operated joint.

Important. If assignment to a group is denied, and a person feels that he cannot work normally, the decision can be appealed by sending documents to the federal ITU bureau. Within a month, the application will be reviewed and a date for re-examination will be set.

Work ability

After the operation, temporary loss of ability to work is observed. If it is accompanied by complications, the patient can be temporarily assigned to group 3 for 1 year. During this time, he must undergo rehabilitation and all medical measures prescribed by the doctor.

But ITU may refuse to assign disability to those whose work activities do not involve stress on their legs. A person can maintain his ability to work if he works in an office as a dispatcher.

Hip replacement is a very complex operation. If complications occur, there may be a violation of motor functions, due to which the patient cannot perform his work duties. In this case, he is entitled to disability.

Complications leading to disability

In the first year after prosthetics, complications may develop that make a person disabled:

1. Dislocations and subluxations that disable the endoprosthesis. More often they occur during heavy physical exertion or due to improper selection of the implant.
2. Infection of the prosthesis. Infection in the tissue area near the artificial joint comes from foci of chronic inflammation in the body (sore teeth, genitourinary diseases, inflammatory processes in bones or cartilage).
3. Vein thrombosis of the limb. Blood clots occur if the patient refuses to undergo rehabilitation or leads a sedentary lifestyle.
4. Periprosthetic fracture. At the site where the wedge-shaped leg of the prosthesis is installed, bone strength decreases and a fracture can occur even several years after endoprosthetics.
5. Neuropathy. It develops when the nerve roots are affected during surgery. Impaired innervation leads to decreased mobility and muscle atrophy.
6. Implant rejection. When using low-quality materials, the prosthesis “does not take root.” Pain, swelling and hyperemia persist in the joint area.

If the listed complications occur, the patient is assigned a temporary disability group and the necessary treatment is prescribed.

Life after joint replacement

Despite the fact that there is a risk of complications, you can refuse surgery only after soberly weighing all the positive and negative aspects. Disability during hip replacement is very rare, which means complications do not arise so often that they should deprive the chance of full life.

After a successful operation and proper rehabilitation, a person can return to their normal life and even resume work, if it does not involve heavy physical activity.

A disability group can be given if there was endoprosthetics of two joints and resulted in serious complications. However, this operation is considered as a method of treatment, and not as a cause of disability.

Disability registration procedure

To apply for disability, you must receive a referral and undergo the necessary examinations. You will need to visit:

• ophthalmologist;
• otolaryngologist;
• neurologist;
• orthopedist;
• therapist.

If there are additional chronic diseases, you will need to see other specialists.

In addition to consulting doctors, you will need a number of clinical and laboratory tests:

• urine and blood tests;
• electrocardiogram;
• fluorography;
• radiography and ultrasound of the joint.

If necessary, a CT or MRI may be prescribed.

During the examination, you should collect the following documents:

• certificate of endoprosthetics performed;
• photocopy of passport;
• a copy of SNILS;
• application to ITU;
• a certificate from your place of work or a document confirming your unemployed status.

A form with the results of the examination is added to the package of documents and the papers are sent for consideration by the commission.

The person is given an examination date, where he must appear with a passport to assess his health and the possibility of receiving a disability group.