Preparation for endoprosthetics surgery is the key to successful treatment

A dual mobility prosthesis looks like this: one implant head is fixed into the other. That, in turn, is placed in a metal cup. This design reduces the likelihood of dislocation and allows for a greater range of motion. The system is recognized as one of the most reliable options for revision surgery. Well suited for elderly patients with weakened muscles and cognitive dysfunction. Global brands produce lines with a variety of sizes of endoprostheses. The selection of the ideal one is carried out based on X-ray images of the joint; the final decision on which components of the implant to install is made directly during the operation.

How is hip surgery performed?

During total arthroplasty, after gaining access to the joint, the surgeon prepares the acetabulum, into which he then installs a cup and liner, fixing it with screws if necessary. After this, in most cases, the head and neck of the femur are sawed off and a stem is installed into the bone canal previously developed with special tools. The head is put on it, which, in turn, is inserted into a liner placed in the acetabulum. The progress of the operation can be seen in the video below.

Types and types of endoprostheses

The endoprosthesis with which the pathologically altered hip joint will be replaced must have sufficient strength, reliable fixation, high functional capabilities and be sufficiently inert in relation to the tissues of the human body. All these requirements are met by products made from high-quality metal alloys, polymers and ceramics. As a rule, one endoprosthesis contains a combination of all these materials. This is due to the fact that in appearance the product resembles a human hip joint.

Its components are presented:

· Endoprosthesis cup. This is the part that should replace the acetabulum of the pelvic bones. It is usually made from ceramics. But there are cups made of polymer materials;

· The head of the prosthesis. It is a metal spherical part coated with polymer. In this way, it is possible to achieve the softest possible glide when rotating the head in the prosthetic cup while performing movements of the limb;

· Prosthetic leg. It is made exclusively of metal, since it experiences the greatest loads compared to other parts of the endoprosthesis. If the head of the prosthesis imitates the head of the femur, then its stem replaces the neck and upper third of the femur.

Another fundamentally important category in the classification of products for hip joint prosthetics is their division into unipolar and bipolar. The first type is represented exclusively by the stem and head, which replace the corresponding structures of the femur. In this case, the joint will be represented by an artificial lower part and a natural acetabulum. Such interventions have been widely performed before. Due to poor functional results and a large number of destruction of the acetabulum with failure of endorpothesis into the pelvic cavity, modern orthopedists practically do not perform it.

Bipolar endoprostheses are often called total. This means that the composition of the product is represented not only by the part that prosthetizes the femur, but also by the cup that acts as the acetabulum. Such endoprostheses are perfectly fixed in bone tissue and are maximally adapted, which significantly increases the effectiveness of the operation and reduces the number of complications. This is especially true when performing endoprosthetics in people with symptoms of osteoporosis (elderly) and in young physically active individuals.

The service life and potential operation of a hip endoprosthesis depends on the quality of the materials from which it is made. Metal endoprostheses are considered the strongest and last for about 20 years. But they have less impressive functional results in terms of motor activity in the affected limb. The most optimal prostheses in terms of motor activity/service life are total endoprostheses, which are made of metal, polymer and ceramics!

Prognosis and possible complications

The service life of a properly installed, high-quality hip replacement with a lifestyle of moderate physical activity is 20-25 years (according to the FDA).[3]

Complications associated with implant installation may occur during and after the intervention:

1. Intraoperative complications include fracture of the femoral shaft, fracture of endoprosthetic components, premature polymerization of bone cement, intraoperative blood loss and fat embolism.
2. In the early period after surgery, complications from anesthesia, contracture, hematomas, vein thrombosis, bedsores, and soft tissue suppuration may occur. Sometimes anemia, pneumonia, urinary retention, neurological pathologies, and acute adrenal insufficiency develop. Dislocation of the head of the endoprosthesis can be observed both in the early and late postoperative period.
3. In the long term, there is a risk of loosening and instability of the implant components. Osteolysis of the bone around the prosthesis and Stress-shielding syndrome may progress - redistribution of bone mass with areas of hypertrophy or atrophy of bone tissue. Late complications include fracture of the femur, endoprosthesis stem, joint infection, ossification, migration of the implant cup, and separation of the greater trochanter of the femur.

If you consult a surgeon in a timely manner, many complications can be successfully treated.

Actions of the doctor and patient a month before surgery

Approximately 4 weeks before surgery, laboratory and instrumental studies. Their goal is to identify factors that will require correction before endoprosthetics. In particular, the following are appointed:

• checking the lungs using x-rays;
• electrocardiogram;
• general blood analysis;
• general urine analysis.

If deviations from the norm are detected, the doctor will prescribe appropriate treatment. During the remaining period, it is possible to eliminate the reasons that will be contraindications for the operation.

At the same stage, the doctor may recommend performing a set of exercises that will promote successful rehabilitation after installation of the endoprosthesis. If during the process the patient feels severe pain, then you need to stop training. After additional consultation, the set of exercises can be adjusted or the problem of this pain can be identified.

Often people do gymnastics incorrectly because there has been no physical activity in their lives for a long time. It is best to watch videos from rehabilitation centers where the main mistakes are explained. If the exercise is unclear, be sure to ask your orthopedic doctor about it.

Rehabilitation after hip replacement

Rehabilitation should be inseparable from surgery. The entire recovery process is divided into three periods:

• from the end of the operation to discharge from the hospital – 15-20 days;
• up to 2-3 months after the intervention;
• up to 1 year after endoprosthetics.

Each of the time periods has its own goals, the implementation of which, at least at first, should be carried out by the patient under the strict guidance of medical personnel. The main objectives of rehabilitation are as follows:

• prevention of postoperative complications;
• normalization of the condition of the uneven muscular system of the leg;
• achieving the maximum possible range of motion in the joint;
• general strengthening of the musculoskeletal system;
• formation of the correct approach, balance and stability during movement and static loads;
• adaptation of the patient to everyday life.

A routine examination by an orthopedist is required at 3, 6 and 12 months after the intervention. If alarming symptoms occur, the patient should immediately contact the doctor who performed the operation.

What to do 2–3 weeks before surgery

During this period, a meeting takes place with an anesthesiologist, who, taking into account the individual characteristics of the patient, especially his age, selects the type of anesthesia. In some cases, medications for existing chronic diseases may be stopped to allow the body to cleanse itself. This reduces the risk of implant rejection and increases the likelihood of well-being during anesthesia. If the doctor has not asked about taking medications on an ongoing basis, you should remind him about this.

Approximately 2 weeks before the scheduled date, you should purchase or rent special equipment and crutches. Many doctors recommend starting to practice walking with crutches before surgery.

At the same time, the doctor should examine the condition of the skin. If irritation, ulcers and any other abnormalities are noted, you can get rid of them in the remaining time. You should also complete all personal affairs, because in the last days before endoprosthetics there will be practically no free time.

If relatives live far away, then you will have to think about arranging your home space yourself. It is necessary to remove all objects that pose a potential danger to a person on crutches and after endoprosthetics:

• slippery mats;
• uncomfortable or slippery seats;
• high thresholds, stretched electrical cords.

Be sure to install as many means as possible that allow you to cling to them in order to move around the apartment. During rehabilitation, from the first days you will need a stable bench for bathing, a tight seat to fix the joints, a cane-handle so as not to bend over when putting on shoes, and a long washcloth.

Hip replacement surgery in Moscow

Operations to install artificial implants of large joints have been launched not only in the capital, but also in regional centers throughout the country. However, performing hip replacement in Moscow suggests the possibility of choice. The large number of institutions performing this intervention increases the likelihood of finding an ideal specialist and clinic.

In government institutions, the operation is carried out by the country's leading specialists with academic degrees and many years of practical experience. In this case, the patient pays for his own peace of mind.

Preparing for surgery

All patients in need of endoprosthetics and who have undergone the necessary studies to determine the condition of the hip joint (X-ray, MRI, ultrasound) are required to undergo a comprehensive examination. This is necessary in order to exclude the presence of possible contraindications.

The set of diagnostic measures includes:

· General clinical blood and urine tests;

· Determination of blood glucose levels, and for persons with diabetes, glycemic profile;

· Biochemical blood test;

· Determination of blood electrolytes (potassium, magnesium, sodium, calcium, chlorine);

· Study of blood clotting (coagulogram, prothrombin index, clotting time and duration of bleeding);

· Determination of blood group and Rh factor;

· Blood test for RV and Australian antigen;

· ECG;

· Study of external respiration functions;

· X-ray examination of the lungs;

· Consultations with specialized specialists in the presence of relevant chronic pathology.

No special preparatory measures are required before hip replacement. If no contraindications are identified during the examination, a surgery date is set. A light dinner is allowed the night before, but not earlier than 8 hours before the intervention. In the morning, the skin in the hip joint and thigh area is carefully shaved. Eating and drinking are prohibited. Before transportation to the operating room, elastic bandaging of the legs is performed, a prophylactic dose of antibiotic and premedication are administered.

Hip replacement price

The cost of a hip joint endoprosthesis starts from 75,000 rubles. for a unipolar prosthesis. An implant for total endoprosthetics costs 120,000-200,000 rubles. To estimate the total cost of treatment, you should take into account the cost of surgery, hospital stay and rehabilitation.

In budgetary institutions in Moscow, primary hip replacement has a lower price than in private clinics. It is in the range of 40,000-105,000 rubles. In the leading state center of St. Petersburg, this operation will cost 37,000 rubles. Revision installation of an implant costs on average 1.5 times more.

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.

Where to get hip replacement in Moscow

Extensive experience in hip replacement in Moscow has been accumulated in the following medical institutions:

• Central Research Institute of Traumatology and Orthopedics named after. N.N. Priorova;
• Central Clinical Hospital of the Russian Academy of Sciences;
• City Clinical Hospital named after S.P. Botkin;
• Road Clinical Hospital named after. N.A. Semashko;
• City Clinical Hospital No. 67 named after L.A. Vorokhobova.

Endoprosthetics are also carried out in other medical centers of the city, including a number of private clinics that provide the service.

Necessary actions after hospital treatment

After the patient is discharged from the hospital, his main task is to carry out the recovery process. The correct and necessary actions of the patient will contribute to accelerating the recovery process. At home, you need to use a walker or crutches. The main requirement when restoring the functions of the hip joint is hygiene and cleanliness. Particular attention should be paid to the incision area. If signs of infection appear, namely:

• persistent swelling
• constant pain
• discharge or bleeding from the incision
• blood in urine
• nausea
• fever and high temperature
• tingling, numbness and tingling in the legs

The patient needs to see a doctor urgently! After endoprosthetics, the patient is recommended to subject the thigh muscles to slight tension and perform breathing exercises under the supervision of a doctor. These steps should be started while in the hospital. Basic recommendations and requirements when conducting gymnastics:

• The incision site must be kept clean
• Do not bend your leg more than 90 degrees
• To avoid dislocation, it is forbidden to turn the leg left and right
• move your leg and hips carefully
• It is recommended to sleep lying on your healthy side or back
• Eat a balanced diet high in calcium and iron, which will help speed up the restoration of muscle strength and tissue healing after surgery. The following foods are healthy: meat, nuts, seeds, fruits and vegetables, fish
• It is recommended not to worry or get into stressful situations
• intense physical activity should be avoided
• To reduce the load on the new joint, it is recommended to use a special pillow
• perform a set of exercises daily to restore the functions of the hip joint
• adhere to the principles of a healthy lifestyle.

Quota hip replacement

Quota hip replacement, in most cases, involves the installation of an implant with a metal-polyethylene friction pair. It is also possible that the state pays for the work of specialists, and the patient purchases the artificial joint independently. The easiest place to get hip replacements done using budget funds is in Moscow—the largest number of quotas are allocated to this region. If the patient’s clinical case fits the list of indications listed in the relevant legal document, with a competent approach to the issue, passing the commission and getting on the waiting list will not be difficult. However, it should be understood that time is not always of the essence - the earlier the operation is performed, the better the prognosis for restoring joint function.

For what diagnoses is surgery strictly necessary?

For a hip fracture, surgery is necessary the sooner the better, since this problem occurs in older people. If the operation is delayed, such patients are difficult to rehabilitate. With arthrosis, everything depends on how the patient assesses his condition, pain syndrome, and whether he is mentally ready to undergo surgery, regardless of what the doctor recommended. If you delay surgery for severe arthrosis, the remaining joints and spine suffer, and deformity appears. The sooner the patient undergoes surgery, the easier and faster the recovery.

Operating unit equipment

• Information System OR1. With its help, the patient’s entire history is displayed on the monitor, and you can maintain video communication with other medical centers and surgeons;
• The Trumpf operating table has replaceable table tops. This eliminates the need to move the patient once again;
• Trilux lighting system;
• Aesculap strength equipment and surgical instruments;
• Dräger anesthesia and respiratory equipment;
• Carbon dioxide laser systems ASKLEPION;
• Endoscopic stands KARL STORZ;
• High-frequency Soring devices with mono-bi and argon plasma coagulation;
• Mobile X-ray unit (C-arm) Ziehm;

Our hospital has 5 operating rooms, where about 4,500 operations are performed per year (vertebrology and orthopedics). Operating rooms can be transformed to accommodate any type of operation.

The operating room corresponds to class 1A in terms of cleanliness. There is a system of hanging media bridges with an assortment of high-precision equipment.

There is a laminar ceiling system where clinically clean air is supplied during surgery. It protects the operation area from germs with a wall.

Indications for hip replacement

Surgical surgical treatment of the hip joint is required if the patient has diseases and changes in the articular structure. Namely:

• coxarthrosis, 3rd degree of disease, presence of deformation of one joint;
• osteoarthritis of the hip joint on both sides, 2nd or 3rd degree of the disease;
• unilateral arthrosis in combination with ankylosis (immobility) of the knee joint, 2nd or 3rd degree of the disease;
• ankylosis of the hip joint resulting from rheumatoid arthritis or ankylosing spondylitis. Can be one- or two-sided;
• damage to one hip joint by coxarthrosis in combination with ankylosis of the opposite limb, 2nd or 3rd degree of the disease;
• malignant cancerous tumors in the ankle joints. First, it is necessary to resect the tumor, and only then proceed with endoprosthetics;
• injuries of the femoral neck or head (fracture, pseudarthrosis in patients over 70 years of age);
• aseptic necrosis (destruction of the femoral head), formed due to impaired blood flow or injury.

Indications and contraindications for surgery

In order for the operation to replace the hip joint to be high-quality and without negative consequences, the surgeon determines the absence of contraindications and the presence of indications for endoprosthetics in the patient. Surgical intervention is not required for every pathology and diagnosis. Doctors often resort to conservative therapy if possible. In addition, endoprosthetics is a rather complex and expensive operation that requires preparation from the surgeon and the patient.

Main indications for hip replacement:

• the hip joint hurts due to aseptic necrosis of the head of the joint;
• the presence of comminuted fractures in the hip bone;
• new fractures and injuries in the femoral neck in patients aged 65+;
• tumors in the neck or head of the femur;
• osteoarthritis of the joints, 3rd or 4th degree of the disease;
• false joints or non-union fractures in the hip bone;
• damage and destruction of joints due to connective tissue diseases: rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis.

The operation also has certain contraindications:

1. Psychoneurological diseases.
2. Pathologies of the cardiovascular system.
3. Tuberculosis.
4. Osteomyelitis in acute or chronic form.