The best hip replacement: how to choose a durable one?

Endoprosthetics involves the installation of an artificial structure on the hip joint. A prosthesis replaces damaged parts of tissue or an entire organ.

Most doctors perform a total joint replacement for a medial femoral neck fracture if the fracture is too close to the femoral head. In this case, specialists replace the femoral head and acetabulum with new ones.

Partial endoprosthetics is performed in cases where:

• the patient is quite elderly or in serious condition;
• the person has a disability group and cannot move independently.

Types of endoprostheses

The classification of prostheses is done according to the method of their fixation:

• CFP construction on a cementless basis;
• hybrid prosthesis;
• classic endoprosthesis.

Each type has advantages and disadvantages. Only a specialist who can identify the patient’s characteristics can select one or another variety.

Despite the variety of information about prostheses on the Internet, those in need of surgery may not study the model range and brands, or look at the cost. The attending physician himself will select the prosthesis necessary for the person, suitable for him according to all the criteria. In recent years, surgeons have often chosen implants from the Zimmer brand, which is popular abroad and has a lot of positive reviews from specialists around the world.

An equally practical and high-quality option is Depuy. Russian brands are also improving their products and offering a wide range of models to the market. For example, the ESI manufacturer. It is quite well known, the production of which is located in Germany. Endoprostheses are resistant to damage and have a long service life. Many surgeons also consider American endoprostheses worthy.

Hip joint: price of prosthesis

The pharmacy does not sell artificial implants for endoprosthetics. They are handled by several companies in large cities. The price will depend on several factors:

• dealer markup;
• brand;
• design features;
• purchase directly from an official representative or through an intermediary in a hospital;
• quality of workmanship and specific model of the prosthesis.

Endoprostheses from almost all companies are represented in Moscow. The cheapest implants are offered by the Taiwanese “UOC”, but doctors’ reviews of this manufacturer are quite wary. The essence of the low price is obvious - Chinese and Taiwanese companies simply clone models of European companies.

A titanium prosthesis from a well-known manufacturer in Moscow costs 99-120 thousand rubles. Asian designs are about 2 times cheaper. If the friction pair is ceramic-ceramic, then the price fluctuates around 200 thousand rubles. The average bill for a classic metal-polyethylene design does not exceed half that of a ceramic product. When purchasing in a hospital, additional markup is possible, masked by additional medical services.

When is surgery necessary?

The hip joint endoprosthesis has several indications:

• severe ankylosis;
• progressive coxarthrosis;
• arthrosis of the hip joint, which developed due to congenital dislocation of the hip in people over the age of 30;
• modification of joints due to damage by tumors to the articular ends and femurs;
• disability that has developed due to any damage or complications of diseases of the bone skeleton.

As with any operation, there are contraindications to the installation of prostheses:

• inflammation in the joint area, which is accompanied by complications;
• osteomyelitis and fistulas;
• tuberculosis of the bone during its exacerbation.

What are endoprostheses made of?

The structure of the prosthesis implies the presence of an artificial ball, which is made from a metal or ceramic base. Another required element is the cavity, which is formed from polyethylene (a durable type of plastic). The structure is fixed to the human body thanks to bone cement.

In the presence of a disease such as osteoporosis of the femur, attachment with bone cement is difficult. In such cases, in addition to it, a metal plate is installed, which performs a fixing function. In some patients, a cementless fastening option can be used.

Stages of preparation for endoprosthetics

Preparation for surgery begins long before the procedure itself. A week before prosthetics, the patient should receive preliminary consultation with a specialist and be examined.

1. No blood transfusion is needed for this operation. The likelihood increases only if hemoglobin levels deviate from the norm.
2. Before prosthetics, it is necessary to get rid of caries, periodontal disease and other dental diseases. This is necessary to prevent infection of the bones during the operation.
3. Before the operation, the doctor discusses with the patient the medications that the patient is taking and, if necessary, stops taking them.
4. Mandatory preoperative diagnostics include blood tests, urine tests, ECG and chest x-ray. Normal results of these tests allow surgical intervention.

Hip replacement for arthrosis (coxarthrosis) Treatment free of charge according to quota

Hip replacement
is an operation consisting of replacing a joint affected by arthrosis with an artificial prosthesis. Typically, endoprosthesis replacement is prescribed at the last stage of coxarthrosis, when the disease is already very advanced or other treatment methods do not help. At the end of the progression of osteoarthritis, such an operation is often the only means of restoring the functionality of the hip joint and the ability to move. Surgery is required when the patient is diagnosed with complete destruction of hyaline cartilage. A healthy hip joint is covered with a layer of hyaline cartilage, i.e. The head of the femur and the cavity of the acetabulum are covered with cartilaginous tissue. The presence of articular cartilage allows for shock absorption of human movements and ensures smooth sliding of joints relative to each other. Problems with the functionality of hyaline cartilage lead to the formation of osteoarthritis.

A type of endoprosthesis ( artificial joints)

What is an endoprosthesis?
Hip endoprostheses are necessary for the patient when the “native joints” refuse to work. Outwardly, they resemble a normal human joint, withstand the same load and are used for the same actions as real joints, they can be extended, bent, and with their help it becomes possible to carry out internal and external rotation, adduction and abduction of the limb. Hip implants are completely different - there are several dozen types. Types of endoprostheses according to their design: - Unipolar - only the femoral head of the hip joint is prosthetic. - Bipolar - both the socket and the head of the bone are prosthetic. Types of prostheses according to the method of their fixation:
- Prostheses with a cementless fixation method - the bones are “adjusted” to the endoprostheses (“ingrowth effect”).
It is used most often for younger patients, as they are more likely to need replacement of the prosthesis after it wears out. - Prostheses with a cement fastening method - are securely fixed using a special solution, are very difficult to remove after wear of the prosthesis, therefore they are installed for people with the least activity. — Hybrid type — the cup of the endoprosthesis is fixed using a cementless method, and its legs are fixed using cement. Types of prostheses according to their material (cup - leg):
- Metal - Polyethylene.
Suitable for both sexes who do not play sports and lead a sedate lifestyle. This pair is considered acceptable for elderly and middle-aged people (when revision of the joint due to wear and tear is not required for a long time). This combination has an average lifespan. - Metal - metal. Usually installed on men who lead an active lifestyle (metal prostheses have the longest service life and are considered the strongest). Not suitable for women planning pregnancy, as metal ions tend to penetrate the fetus, increasing the iron concentration by 15%. - Ceramics - ceramics. It is suitable for all patients at any age, but the choice of a ceramic pair is not suitable for many due to their rather high cost. The advantages of this type of prosthesis include their durability and non-toxicity. Ceramics - Polyethylene. A relatively inexpensive type of endoprosthesis. This ceramic combination is better suited for older patients, as in young people with high activity they will quickly fail (they have a high degree of wear and an average lifespan). What can be called an ideal endoprosthesis? Sometimes complications occur during endoprosthetics (approximately 5–15% of all cases). They are caused by the wrong choice of endoprosthesis, instability of the aseptic profile, fracture of the prosthesis in the leg, infections, hematomas, and chronic diseases. Therefore, it is very important to choose the right endoprosthesis. Unfortunately, it is impossible to recommend specific endoprostheses now, since there are no universal models. All dentures are different, and only an experienced specialist can best understand their features. People who know about dentures only from reviews on the Internet are too tempted to make a choice based only on price. Remember: there are quite a lot of high-quality and affordable endoprostheses, and it is not at all necessary that the more expensive they are, the better. And although hip joint endoprostheses should be the most optimal in terms of price-quality combination, what is important in endoprosthetics is the quality of the operation itself, and not the cost of materials. Sometimes incorrect installation of an implant can damage even the most expensive orthopedic product, but a carefully installed mid-price model can last for decades. The main success factor in endoprosthetics is the experience of the surgeon performing the operation, and not the price of endoprostheses. Main manufacturers
Surgeons who do a lot of prosthetics have preferences when choosing prostheses of one type or another. The most important players in the market for the manufacture of high-quality prostheses are the following companies: Smith & Nephew, DePuy Synthes, Stryker, Zimmer - Biomet, Aesculap. Modern medicine offers more than fifty different types of endoprostheses. Each of these modifications provides the same functionality as nature intended. However, the service life is not as long as we would like: the artificial analog can withstand natural loads for up to 15-20 years with a high-quality operation.

Hip replacement.

Before the operation, a consultation with the patient is carried out.
Issues of endoprosthesis replacement, possible complications and risks are discussed, and the size of the prosthesis is carefully selected. The main risks of the operation are associated with the possibility of infection in the body, large blood losses and thrombosis of blood vessels during surgery, and there is also the possibility of dislocation of the endoprosthesis. A couple of days before the operation, the patient is hospitalized and fully examined. The hip replacement procedure itself takes from one and a half to three hours. Endoprosthetics is performed by a highly qualified doctor, because The operation is classified as complex. The procedure consists of removing the hip joint affected by arthrosis and installing it with an artificial implant, consisting, as already mentioned, of metal, plastic or ceramic. In the postoperative period, a group of drugs with analgesic anti-inflammatory action is prescribed. To fix the pelvis in the desired position, a bolster can be placed under the hip area and between the legs. Generally, some activity in the hospital bed is acceptable the day after surgery. The doctor allows you to squat and make some static movements on the second day. With the help of additional means (a crutch), the patient is allowed to move on the third day. Sutures are removed by the end of the second week after endoprosthetics. How to choose a surgeon
Do not think that the best surgeon is an older doctor with various awards. For the success of endoprosthetics, it is not the age of the specialist that is important, but how many operations on the hip joint he has performed. In many clinics you can find 30-year-old doctors who perform 3-5 hip replacements every day. A surgeon who performs at least 50 surgical interventions on the hip joint per year can be considered experienced. In the case of fewer operations, the surgeon is considered a student regardless of the amount of gray hair on his head. In addition to the qualifications of a particular surgeon, you need to study reviews about the clinic where you are going to have hip surgery. The fact is that no matter how experienced the doctor is, without the necessary equipment he will not be able to perform endoprosthetics at the proper level. To carry out the operation, not only the prostheses themselves are required, but also the “correct” instruments (power equipment and other materials considered consumables). When choosing a surgeon, it is better to give preference not to a “professor with titles”, but to a practicing specialist. There are many different endoprostheses, differing in type of fastening, structure, and service life. It is better not to buy a prosthesis yourself. Trust your surgeon to choose the appropriate endoprosthesis.

Rehabilitation after surgery. The patient is discharged 10-12 days after the operation. Further rehabilitation is carried out at home, following all doctor’s instructions. In the event of a complication of endoprosthetics, it is advisable to transfer the patient to a special rehabilitation center, where proper monitoring and care by rehabilitation doctors will be provided. The person being operated on must comply with the load restrictions on the artificial hip joint. Typically this period is up to two months. Complications range from 5 to 15% of all operations. Every year this percentage becomes smaller, because... The technique is constantly being refined and more advanced means are being used for successful rehabilitation. After 95% of endoprosthetics operations performed for coxarthrosis, a person again gets the opportunity to move, bend, returning to normal life, even playing sports. The service life of the endoprosthesis is 15 years, maximum 25 years. It should be noted that the more load the prosthesis receives, the faster the implant wears out. The service life of a hip replacement is reduced by excess weight and high mobility (applies to athletes returning to their previous lifestyle).