Partial or complete hip replacement at an affordable price in Moscow is performed in partner clinics of the Yusupov Hospital. After surgery, patients need to restore motor function. Specialists at the rehabilitation clinic provide comprehensive rehabilitation therapy after hip replacement surgery.
As a result of treatment, patients can move independently: walk, swim, play golf, ride a bicycle. A hip replacement will prevent you from doing intense sports such as running, jumping and skiing in the future. Patients will be able to walk without pain or crutches, which significantly improves their quality of life. Artificial hip implants are designed to last 15-20 years. After this period, they are replaced with new ones.
Indications and contraindications for hip replacement
The generally accepted indications for hip replacement are:
- unilateral deforming arthrosis of the III degree;
- bilateral deforming arthrosis of II-III degree;
- grade III deforming coxarthrosis and ankylosis of one of the large joints on the same limb;
- bilateral fibrous or bony ankylosis of the hip joints (Bechterew's disease);
- unilateral coxarthrosis of grade II-III of one hip joint and ankylosis of the contralateral one;
- fracture and pseudarthrosis of the femoral neck in patients over 70 years of age;
- aseptic necrosis of the femoral head of the III-IV degree;
- post-traumatic coxarthrosis of the third degree due to severe damage to the acetabulum;
- neoplasms in the head and neck of the femur, which require resection of the pathological focus.
The operation is not performed if the following contraindications are present:
- inability to move independently;
- severe chronic diseases of the cardiovascular system (decompensated heart defects, heart failure of the third degree, complex heart rhythm disorders, conduction disorders - atrioventricular block of the third degree with impaired hemodynamics, three-fascicular block);
- pathologies of external respiration with chronic respiratory failure of II-III degree;
- inflammatory process in the hip joint;
- unsanitized foci of chronic infection;
- previous sepsis (generalized infection) with the presence of even sanitized metastatic foci;
- hemiparesis on the side of the planned operation;
- severe osteopenia;
- polyallergies;
- absence of the medullary canal of the femur.
What happens during the operation?
After the patient is taken to the operating room and placed on the operating table, anesthesia is performed. Typically, the method of anesthesia is chosen by the patient together with the anesthesiologist. Since the duration of the operation is from 1.5-2 to 3-3.5 hours, either spinal anesthesia or full combined anesthesia with controlled breathing and complete muscle relaxation are considered optimal. The first method is less harmful, therefore it is preferable for the elderly.
After anesthesia, surgeons prepare the surgical field and access the hip joint. The size of the incision, which passes through the central part of the joint, is about 20 cm. After this, the joint capsule is opened and the head of the femur is brought out into the wound. Its resection is performed along the pertrochanteric line until the medullary canal is exposed.
The bone is modeled in accordance with the shape of the endoprosthesis, which is fixed in it in one of the optimal ways (usually using cement). Then the acetabulum is processed with a drill with a special attachment in order to completely remove the articular cartilage from its surface. The prosthetic cup is installed and fixed into the prepared funnel.
The prosthetic surfaces are aligned and strengthened by suturing the dissected tissues. An active suction drainage is installed in the wound, through which the discharge will flow out. A bandage is applied.
Complications after hip replacement
After surgery, pus may ooze from the wound. The presence of a purulent focus has a detrimental effect on the strength of fixation of the endoprosthesis, causing its loosening and instability. The main principle of treatment is long-term antibacterial therapy after determining the sensitivity of microorganisms to antibiotics, and abundant lavage of the wound with antiseptic solutions.
Pulmonary embolism is one of the most serious complications of the postoperative period. The culprit of thrombosis is the lack of early rehabilitation and necessary drug treatment, the patient’s prolonged stay in an immobilized state. For this reason, rehabilitation specialists at the Yusupov Hospital begin early rehabilitation on the first day after surgery.
Periprosthetic fracture is a violation of the integrity of the femur in the stem area with an unstable and stable prosthesis, which occurs during surgery or at any time after surgery. Therapy, depending on the type and severity of the damage, consists of using one of the methods of osteosynthesis. The leg of the prosthesis is replaced with a more suitable configuration.
After hip replacement, neuropathic syndrome may develop - damage to the peroneal nerve, which is part of the structure of the greater sciatic nerve. It can be triggered by lengthening of the leg after prosthetics, pressure of the resulting hematoma on the nerve formation, and, less commonly, intraoperative damage due to careless actions of the surgeon. Nerve restoration is performed surgically or through physical rehabilitation.
Currently, there are about 70 types of different designs. The success of the hip replacement procedure depends on the patients' strict compliance with the special rehabilitation program and the doctor's recommendations. The patient is given instructions on how to apply measured loads on the operated leg through physical exercises.
Infectious complications
Infectious processes can occur both in the area of the surgical wound and deeper, in the place where the artificial prosthesis is installed. An infectious complication is characterized by the appearance of pain at the site of its development, as well as swelling and redness of the skin.
To avoid the development of infectious processes, as well as to treat when inflammation occurs, antibiotics and other medications are used. In some cases, it may be necessary to undergo repeated surgery to replace the prosthesis.
Rehabilitation in the early postoperative period
After hip replacement surgery, the patient remains in the intensive care unit under the supervision of doctors until the effects of anesthesia wear off. Then he is transferred to the ward. After a few hours, the patient is helped out of bed and placed in a chair. After 1-2 days he can already stand steadily and walk with support. All this time, the patient receives the necessary anti-inflammatory and painkillers.
The duration of the early postoperative period ranges from 7 to 10 days. The main goal of rehabilitation measures is to prevent possible complications after hip replacement from the respiratory and cardiovascular systems, and to improve the mobility of the prosthesis.
For the first three days after surgery, the patient is allowed to lie only on his back. The limb is fixed with a bolster in a position with slight abduction to the side. In this case, the foot should be fixed strictly perpendicular to the shin, and the toes should be pointed upward. Change the position of the knee joint 3-4 times a day for 10-20 minutes, using a special roller for this. You can roll over onto your side on the non-operated side from the fourth day. You are allowed to lie on your stomach from 5-8 days after endoprosthetics. To avoid vascular diseases, the first week after surgery, both limbs are wrapped with elastic bandages, and then a bandage is applied for one week only during the daytime.
In the first weeks after surgery, rehabilitation specialists gradually introduce gentle exercises from exercise therapy programs. During the same period, the patient takes antibiotics and painkillers. Correct patient behavior with a replaced joint will allow you to easily go through a recovery period lasting from 3 to 6 months. The patient, with the help of a physical therapy instructor, learns to tense the muscles of the thigh and ankle. Exercise increases blood flow to the muscles and helps prevent swelling and blood clots. The exercises are performed under the guidance of an experienced exercise therapy instructor.
Possible complications
Hip replacement is a large and complex procedure.
Its complications can include:
· Bleeding from a postoperative wound;
· Formation of blood clots in the veins of the lower extremities with migration into the vessels of the lungs and pulmonary embolism;
· Suppuration of the postoperative wound and endoprosthesis;
· Hematoma of the operated area;
· Failure of the endoprosthesis and its rejection;
· Complications of the heart and brain in the presence of chronic pathology (ischemic heart disease, atherosclerosis, dyscirculatory encephalopathy, etc.);
· Dislocation of the endoprosthesis.
Correctly defined indications and contraindications for endoprosthetics, combined with careful preparation for the intervention and the sequence of its implementation, minimize the risk of postoperative complications. But you can never exclude them even if you follow all the rules and recommendations!
Real results
According to statistical data based on long-term observation of operated patients and personal experience of leading specialists involved in hip replacement, most patients are satisfied with the results of treatment. If the operation is performed on somatically healthy individuals of relatively young age who do not have concomitant diseases, the functional abilities of the hip joint are almost completely restored. This allows a person to walk and engage in physical activity. Sports and movements associated with forceful tension of the lower extremities are not possible. Patients are either unable to perform them, or during their implementation, a violation of the integrity of the endoprosthesis occurs.
Like any operation, endoprosthetics is not without complications and unsatisfactory results. They are mainly associated with older age, concomitant diseases and non-compliance by patients with the treatment regimen in the early and late postoperative period. More than 20% of the operated patients expected better results from endoprosthetics compared to those that were obtained.
Thromboembolism
Secondly, thromboembolism. To avoid such a complication, the attending physician will select one of the coagulants, for example, Fragmin, Klesan, warfarin.
An anticoagulant prevents blood clotting. Many people believe that they make it more liquid, but in fact they simply prevent blood clots from forming.
Why are blood clots dangerous? A major surgery such as a hip replacement usually involves a person losing mobility for a period of time.
This means that the blood begins to stagnate, and there is an additional risk of blood clots.
The most common areas of pathology formation are the legs.
When blood clots break off, they can travel to any organs and tissues, including the lungs. This can be fatal.
That is why increased attention is paid to the prevention of thromboembolism during orthopedic operations in Israel.
Dislocation of the endoprosthesis
Almost any patient who has had a hip replacement can experience hip dislocation.
Therefore, special care must be taken in the first few weeks after the intervention.
After the intervention, the doctor will definitely warn you to avoid excessive twisting or flexion of the operated hip.
It is easier to avoid complications of this kind than to treat them. Wearing a special design called a “brace” will help reduce the risk of dislocations.
This device is necessary in order to limit the excessive range of motion of the joint. Unfortunately, there is no 100% guarantee that you will not get a dislocation.
However, the faster your soft tissue, which helps hold the joint in place, recovers, the more likely it is that you will not experience such an injury.
Usually the soft tissues return to normal approximately 3 months after surgery.
If a dislocation does occur, you must immediately contact an orthopedic specialist.
Either to the clinic where you had endoprosthetics, or to the emergency room.
Through a simple intervention, the doctor will put the head of the artificial hip joint in place.