What are the dangers of joint replacement?

When arthrosis enters the third stage, at an appointment with a specialist you may hear: joint replacement is recommended. Endoprosthesis replacement is indicated for serious damage to the joint and its parts, severe pain and limited mobility. How does this operation take place, what risks does it entail and is there an alternative?

Most often, endoprosthetics are performed on the knee and hip joints.

What is endoprosthetics

Endoprosthetics is the surgical replacement of a natural joint with a structure made of ceramic, metal or especially durable plastic. With the help of an artificial implant, one goal is pursued - to simulate and replace a non-working joint. If everything is done correctly, the endoprosthesis provides 10-20 years of normal motor activity.

The following materials are used in joint replacement:

stainless steel alloys;
special cement made of acrylic resin, cobalt and chromium alloys - for fixing endoprostheses;
titanium alloys – as the basis for sliding components;
heavy-duty polyethylene and aluminum oxide ceramics - for treating sliding surfaces.

Each endoprosthesis undergoes several levels of control and is certified

What Can You Expect After Knee Replacement Surgery?

Before you have a knee replacement, you should consider how much it will affect your return to normal life. Most people expect this surgery to completely solve their problem, but this is an unrealistic expectation. Endoprosthesis replacement significantly reduces pain, improves mobility and improves quality of life. About 8 weeks after surgery, you can engage in activities such as walking, swimming, cycling, driving, and climbing stairs. However, keep in mind that an artificial joint will never act like a healthy knee for you and you must take great care of it. Activities such as running, jumping, hiking, skiing, tennis, and lifting heavy objects can pose a serious threat to the survival of a knee replacement. However, this surgery will significantly reduce the pain caused by a knee abrasion, and for people who experience pain even at rest, this may be the only thing they look forward to from the surgery. However, to have a comfortable life after surgery, you will need to take care of your artificial knee for many years.

What are the indications for joint replacement?

The operation is indicated for patients with complete or almost complete loss of motor function of the joint. Such symptoms are possible when:

all types of osteoarthritis, arthrosis and arthritis;
intra-articular fractures;
joint dysplasia;
femoral neck fracture;
Bekhterev's disease;
false joints and some other diagnoses.

One of the indications for endoprosthetics is the third stage of arthrosis

How is a hip replacement performed?

Endoprosthesis replacement as part of the treatment of arthrosis of the hip joint involves several stages:

high-precision removal of the destroyed femoral head;
careful preparation of the acetabular element;
installation of endoprosthesis components in prepared anatomical areas.

If only the femoral head is damaged, only the distal part of the femur needs to be replaced. In this case, the acetabulum is not touched. If both surfaces are destroyed, a total implant is installed.

The hip joint implant completely replicates the geometric shapes of the natural

What is complete and incomplete endoprosthetics?

If the joint is completely damaged, a total replacement is performed. In other cases, only worn parts, such as the socket or head of the bone, are replaced. In the case of hip replacement, the following options are possible:

total replacement - resection of all components of the joint, installation of a complete endoprosthesis (femoral head plus acetabular element);
unipolar replacement - installation of a spherical element of the femur, which will interact with the natural cartilage of the pelvic bones;
bipolar replacement is one of the types of unipolar prosthetics, which is used less and less today;
superficial replacement - involves only grinding the head/acetabulum and covering them with a smooth cap implant.

Total replacement is most effective: positive prognosis is 15-30 years

Steps to Take Care of Your New Knee

There are many steps you can take to care for your new knee joint, but strengthening exercises are an important part of your recovery plan. Perform these exercises regularly under the supervision of a physical therapist so that you can quickly resume your daily routine. The following steps will also help you take care of your knee replacement:

To reduce swelling, elevate your leg while seated and apply an ice pack to the operated area every three to four hours for 20 minutes.
For the first six weeks after surgery, do not sit cross-legged.
Avoid physical activities that strain your knee.
Do gentle exercises and light walking to reduce knee stiffness.
Never place a pillow under your knee while sitting or sleeping.
Do not drive for 6-8 weeks after surgery and be sure to consult with your doctor before you can resume driving.
For the first three months, do not do heavy work at all, such as vacuuming or moving furniture. You can only do simple things like dusting and doing laundry.
Do not have sex for 6-8 weeks after surgery.

How is rehabilitation going?

Endoprosthesis replacement is a complex surgical operation that requires serious monitoring in the postoperative period. The patient remains in the intensive care unit for some time and is then transferred to a regular unit. After the operation, on the second day, he is prescribed a rehabilitation program.

Rehabilitation treatment takes about three months. The person spends the first 2-3 weeks in the clinic, and then completes the appointments at home - strictly according to the instructions, and ideally - in a good specialized medical center. In the case of the hip joint, rehabilitation, even in the later stages, is best done under the supervision of specialists.

It is 2-3 months after endoprosthesis replacement that the risk of endoprosthesis dislocation, loosening and other troubles increases. Inspired by improvements, a person overestimates his capabilities and unreasonably increases his workload. In fact, the strongest bonding of the prosthesis to the bone and muscles occurs only 3-4 months after surgery, so the load must be strictly dosed throughout this period.

Hip replacement is followed by 3-4 months of rehabilitation

Postoperative complications

The following complications may occur during and after knee replacement surgery:

thrombosis of the veins of the lower extremities
- anticoagulants, compression garments, massage and other physiotherapeutic procedures are used to prevent it;
infection of the knee joint
- if it occurs, repeated opening and sanitation of the joint cavity, taking antibiotics are prescribed;
dislocation of the prosthesis
- to prevent it in the first days after surgery, all movements of the operated limb must be performed under the supervision of a doctor;
contracture (limitation of mobility) of the joint
- therapeutic exercises, massage and other physiotherapeutic procedures are used to overcome it;
rejection of the implant by the immune system
- to prevent this from happening, before the operation the patient undergoes a test for compatibility with various materials.

In general, such complications are unlikely to occur when treated in a licensed medical facility. However, there is still such a risk, so the patient must be prepared for it.

Are there any contraindications to surgery?

Endoprosthetics is a serious intervention in the functioning of the body, so there are many contraindications to it. Among the absolute ones are:

diseases of the respiratory, cardiovascular system in the stage of decompensation;
a focus of purulent infection in the body, be it otitis media, sinusitis, tonsillitis, caries, etc.;
neuromuscular and mental disorders;
polyallergy;
infection in the joint (active or latent) for less than three months;
thrombophlebitis, thromboembolism and other vascular diseases of the lower extremities;
skeletal immaturity, etc.

For some diagnoses, the appropriateness of surgery is determined by the doctor. Sometimes it is contraindicated in cases of cancer, liver failure, hormonal osteopathy, chronic somatic diseases, and third-degree obesity.

Endoprosthetics has a wide list of contraindications

Knee arthroplasty

With age, joints wear out, and throughout life they can be subjected to excessive stress and unexpectedly injured. All joints of the body are affected, but the knee joint is one of the most active joints, so it is most often affected. Implantation of a new knee joint confidently holds second place in terms of the frequency of endoprosthetics, while the hip joint is in first place in terms of replacement frequency.

Currently, about hundreds of thousands of primary knee replacement surgeries are performed annually around the world.

In addition to injuries and age-related wear and tear of the knee joint, there are many more pathologies, the development of which results in the need for surgical intervention. These may be inflammatory processes, impaired bone formation, gout and other metabolic changes. Some of them lead to disability. In order to improve the quality of life, the most optimal solution in many cases is timely joint replacement. With a new joint, a person gains forgotten enthusiasm, he begins (continues) to play sports, and new opportunities open up in everyday life, work, and leisure activities.

The technique of endoprosthetics surgery is polished to the smallest nuances and is not difficult for a qualified specialist. The affected joint fragments are removed, and in their place artificial prostheses made of different materials are attached - metal alloys, ceramic and polymer compositions, or combinations thereof. These artificial structures (prostheses) are called implants.

The medical industry produces a diverse line of prostheses that satisfy any demand; types of implants are constantly being improved. Thanks to timely surgery in a specialized medical center, with the right choice of a competent specialist, you can get rid of suffering and maintain a completely acceptable active life for a long time.

Indications and contraindications for knee arthroplasty

Endoprosthesis replacement is prescribed only if all therapeutic measures have been exhausted and there is no result. The patient continues to complain of pain, he cannot move the limb freely, and after some time walking itself becomes impossible. The question of knee replacement arises. If the patient decides to undergo surgery, it is necessary to carefully examine it before endoprosthetics, since there are absolute contraindications when implanting an artificial joint is not recommended, for example,

Main types of operations

Thanks to surgical intervention, destroyed articular components are replaced with implants that replicate the anatomy of the removed structures. Currently, there are two types of interventions:

complete replacement with an artificial joint (the knee is completely replaced);
partial endoprosthetics (damaged components of the articulation are replaced in case of pathology of only one (internal or external) condyle);

The type of operation is determined by the doctor. He identifies contraindications, conducts a thorough examination, and talks in detail with the patient. A good specialist will be interested in everything - a person’s lifestyle, his activity, aspirations and motivations, willingness to interact with a doctor, the desire to be healthy, the environment and support of the patient. The doctor must warn not only the patient, but also those close to him about possible postoperative risks. Before the operation, you need to get rid of chronic foci of infection and take care of purchasing crutches (walkers), a home exercise machine for developing the joint, adjust your diet and create a menu rich in essential nutrients and microelements for bone tissue.

A separate conversation is held with the patient’s relatives who will be with him at home. The doctor tells you what care items need to be purchased, how important it is to have a properly organized safe space in the apartment (no sharp corners, no wires lying on the floor), about non-slip shoes, about a flashlight that should always be at hand at night, about the correct choice of crutches and etc.

Partial endoprosthetics

This technique is not very popular; it is used in people of advanced age, when their physical activity decreases, or in bedridden patients. During the intervention, damaged parts are removed and replaced with new components. Careful removal of the dead layer allows you to leave as much of your living bone tissue as possible.

Advantages of the operation:

minimally invasive;
local anesthesia;
fast rehabilitation;
possible preservation of ligaments;
gentle injury to soft tissues;
legs remain the same length;
the cost is significantly lower.

After partial prosthetics, pain disappears within a week, and gait is restored after 1-2 months. With the new implant, the operated patient can climb up and down stairs, squat, move the limb to the side and rotate it.

Cons of the operation

The most important disadvantage is the limited service life of the artificial joint. If you move little, the joint can be functional for up to 5-8 years, and then you have to repeat the operation.

Total knee replacement

With total arthroplasty, the knee is completely replaced with a new design made from high-quality materials in different combinations. The service life of such artificial joints reaches 20 years. The operation is indicated for young active people involved in sports and physical education enthusiasts.

Flaws:

long-term rehabilitation;
risk of major blood loss;
time of the operation.

Today, modern clinics use minimally invasive total knee replacement. This is a new technology that is significantly superior to the classic version of the operation.

Pros:

reduction of rehabilitation time by half;
minimal postoperative pain;
ligaments and vessels remain unharmed;
muscles are not injured;
takes place without general anesthesia;
minimum blood loss;
loads are possible already on the first day after surgery.

Fixation options

In addition to different approaches to intervention, different methods of fixation can be used - with and without cement. Cementless fixation is good because over time the implant connects with bone tissue, which literally grows into it. This technology is used in patients without osteoporosis. The cement binding component is usually used in people 60+ with symptoms of osteopenia and osteoporosis. The correct combination of components makes it possible to achieve effective treatment and extend the life of the prosthesis.

Another step forward with innovative VERILAST technology

Today's patients have increased demands on their activity, so they expect high-quality artificial joints that will serve them long and reliably. And doctors are doing everything possible to avoid subsequent operations. “The innovative combination of materials used by VERILAST technology takes a big step forward in this direction,” summarize Prof. Dr. Pfeil and his team of specialists from the orthopedic clinic of St. Joseph's Hospital in Wiesbaden (Germany).

The reasons for the destruction of implants are varied and therefore high demands are placed on the properties of the materials and raw materials from which they are made.

There are several aspects to consider when performing knee replacement surgery. In the case of posterior knee replacement, which is the most commonly used method, the implant consists of fragments of femoral and tibial bones and a polymer plate. There is a relationship between the resin plate and the femoral component, so adequate contact is essential. It should be close to physiological, not irritate the bone, not cause friction and be wear-resistant.

When implanting a femoral component made of steel and titanium, the disadvantage is that their surface layer is too rough, causing the plate of polymer material to wear out quickly. The solution is to make the femur component where it meets the plate from a zirconium-niobium alloy. The surface of this metal alloy can be converted into metal ceramics (oxynium) by high heat treatment. This opens up big advantages: there is no risk of allergies, there is no risk of destruction and there is no risk of obtaining an extremely smooth surface. “By combining this metal ceramic with a highly cross-linked polymer material, the wear rate of this knee replacement can be reduced, so that even the youngest patients may not need a second operation,” says joint replacement specialist Prof. Dr. Pfeil.

New technology opens up great prospects. The introduction of VERILAST* technology for knee replacement was preceded by detailed simulations with more than 45 million load cycles, the results of which confirm the claims of the product name (VERILAST= It lasts very long (English) = hält sehr lange (German) = it lasts very long (German) ). After a simulated 30-year period, wear rates were 80% lower than using standard materials after just three years.

Conclusion

Implantation of artificial joints is one of the most successful and widespread intervention techniques in modern medicine. Therefore, the number of implanted endoprostheses has been steadily increasing in recent years. A total knee replacement has a 90% chance of remaining viable for 15-20 years. And this is just the beginning! Progress in terms of the survival time of implanted prostheses is obvious. High-quality prostheses from well-known foreign brands preserve the anatomical structure of the knee and provide a wide range of flexion. With the right choice of a surgeon with extensive experience (the success of the operation depends 50% on the skill of the doctor) and a specialized orthopedic clinic, you can significantly extend the life of the prosthesis. The main goal pursued by doctors when replacing a joint is painless operation of the joint and a stable absence of infection. A lot depends on the patient’s conscientiousness and perseverance, since there is a very difficult post-operative and home recovery ahead.

The rehabilitation period is quite long, you need to have a great desire to follow all the doctor’s recommendations, patience - to do physical exercises every day, learn to walk again and follow a strict daily routine. But thanks to the joint coordinated actions of the doctor and the patient, thanks to the patient’s hard work during the recovery period, excellent results can be achieved: the patient will get rid of pain and return to his usual way of life, at least for the next 15-20 years, with careful treatment of his new joint.

What are the complications?

Like any other surgical intervention, endoprosthetics can result in complications, including:

external or internal infection (with insufficient care of the surgical wound or the presence of any infection in the body);
pulmonary embolism (to prevent this outcome, anticoagulants and exercise therapy are prescribed);
damage to the endoprosthesis due to trauma;
dislocations and subluxations of the implant head due to improper motor mode.

When an infectious process develops, intensive anti-infective treatment is prescribed. If the situation becomes more complicated, repeat endoprosthesis replacement is possible.

Knee replacement takes place in 3 stages - preparation, surgery itself and rehabilitation. A qualified orthopedic traumatologist talks about the features of the procedure:

How to prepare properly?

Before installing a knee endoprosthesis, it is necessary to undergo a comprehensive examination of bone and cartilage tissue, as well as the body as a whole. Methods for assessing the condition of the skeleton include the following examinations:

densitometry – allows you to measure bone mineral density and determine the severity of osteopenia and the degree of osteoporosis;
blood test for ionized calcium;
determination of the level of osteoresorption marker b-Cross Laps (i-ctx) in serum.

If excessively reduced bone density is detected during preoperative preparation, additional therapeutic measures are necessary. The patient is prescribed medications that regulate phosphorus-calcium metabolism, vitamin D and calcium preparations. If significant risk factors are present, preventive therapy may be recommended. This significantly reduces the risk of developing early joint instability.[iii]

To assess the condition of the area of proposed intervention, several instrumental studies are carried out:

X-ray of both knee joints in 2 projections;
Ultrasound;
magnetic resonance imaging;
arthroscopy (if indicated).

A series of laboratory tests are prescribed to assess the general condition of the patient, the health of his internal organs and the hemostatic system. Other additional laboratory tests may be performed on an individual basis. For example, patients with a history of frequent allergic reactions are prescribed skin patch tests.

The patient has the opportunity to independently improve the prognosis after surgery: strengthening the immune system with proper nutrition, proper hardening, weight loss - all this objectively helps the body successfully undergo the operation and quickly adapt to new conditions.

Before knee replacement, it is advisable for a patient to master a set of exercises to strengthen muscles and train joints, which will be used during rehabilitation after surgery. This will speed up recovery after knee replacement; for the same purpose, the patient is trained in the correct handling of auxiliary devices: crutches, a cane, a stick.

Is there an alternative to surgery?

For those who are indicated for treatment of arthrosis or osteoarthritis through surgery, some rheumatologists and orthopedists offer a safer alternative - Noltrex synovial fluid viscoprosthesis. The drug is a liquid endoprosthesis that is injected into the joint cavity and replenishes the deficiency of joint fluid. Why is this effective?

Noltrex covers the joint surfaces and synovium, creating a shock-absorbing effect. Due to this, mechanical friction of the joint stops and further destruction of cartilage is stopped. With the advent of artificial synovial fluid, the joint space widens and pain and irritation disappear.

One course of Noltrex injections, consisting of 2-5 injections, is enough for 1-2 years - depending on the degree of damage to the joint. The effect occurs after one to two weeks and lasts for a long time. A person does not need to spend several weeks in a hospital, subject his body to general or spinal anesthesia, risk complications and limit himself for several months. That is why progressive specialists are increasingly recommending intra-articular injections as a worthy alternative to joint replacement surgery.

Rehabilitation

The recovery period after knee replacement surgery in the clinic lasts on average 10 days. To speed up its healing and eliminate postoperative complications, the doctor prescribes the following medications:

anticoagulants that prevent the formation of blood clots in the vessels of the legs;
anti-inflammatory and analgesic drugs that relieve pain;
antibiotics that reduce the risk of developing bacterial infections in the wound.

To restore joint mobility, prevent thrombosis and congestion in the operated limb, a course of therapeutic exercises is also prescribed, which are specially selected by the doctor. On average, already on the second day after surgery, the patient can perform simple movements, and on days 3-4 - get out of the hospital bed and walk with crutches.

After discharge from the hospital, the knee joint is not yet fully restored, so at home the patient should also follow a number of recommendations:

gradually increase the duration of walking - first with support on crutches, then without them;
train everyday movements such as sitting up and getting up from a chair, walking up the stairs;
perform therapeutic exercises aimed at restoring mobility and strengthening the knee joint;
eat foods rich in vitamins, iron and calcium compounds for rapid tissue healing and restoration of blood flow.

If you strictly follow medical recommendations, complete recovery occurs within 4-6 weeks after surgery. The prosthetic knee joint completely restores its mobility, provides full movement, including high-intensity movement - running, jumping, etc.