Hip replacement surgery and rehabilitation features

The hip joints (HJ) are the largest in size among all the joints in the human body. Every day they experience serious stress and, as the body ages, they tend to wear out, which leads to the development of coxarthrosis. Injuries to the hip joint of various kinds, as well as a number of other disorders, cannot be excluded. All this can lead to a decrease in the functionality of the hip joint, up to its complete immobilization. In such situations, the only way to avoid disability is to undergo surgery. Today, the most effective and safe is endoprosthesis replacement or replacement of the hip joint with an artificial endoprosthesis.

Features of hip replacement surgery

The hip joint is formed by the head of the femur, which is connected to its body through the thinner neck of the femur, and the acetabulum. The latter is a cup-shaped depression in the pelvic bone. The head of the femur and the surface of the acetabulum are covered with thin, perfectly smooth hyaline cartilage, which is lubricated by the fluid produced by the synovial membrane. This ensures ease of sliding of the femoral head in the acetabulum and the ability to freely carry out movements in the hip joint.

If changes occur in any of these structures (hyaline cartilage, bones, synovial membrane) due to the action of certain factors, the functioning of the joint is inevitably disrupted. Initially, this is accompanied by pain, which tends to intensify over time, then restrictions on the range of motion are added and ultimately the joint may completely lose mobility. In such situations, different types of surgical interventions can be performed, but the most appropriate is hip replacement, since it ensures complete restoration of the functionality of the hip joint and provides the most lasting effect.

Hip replacement is a modern, high-tech operation that involves removing worn or damaged elements of the hip joint and installing an artificial endoprosthesis instead. They reproduce the anatomy of the hip joint as accurately as possible, which ensures complete restoration of its functions. At the same time, complications after endoprosthetics occur in less than 1-2% of cases, which is an extremely low figure. But in order for the operation to be successful, and for the installed endoprosthesis to function correctly and for a long time, it is better to carry it out in specialized centers where orthopedic surgeons have extensive experience in replacing hip joints.

Today, more than 500 thousand hip replacement surgeries are performed annually around the world, and patients respond very positively to the results. Example of a hip replacement surgery

The only drawback of endoprostheses is the need to replace them after 15-20 years (sometimes they last 30 years) or if the prosthesis fails prematurely due to traumatic or other factors. In such situations, a revision operation is performed and, if necessary, the endoprosthesis is replaced.

When is hip replacement required?

Hip replacement surgery has many indications. It is performed when conservative therapy can no longer ensure maintaining a person’s quality of life at a sufficiently high level, i.e., relieve him of pain and limitations in the mobility of the hip joint. In general, hip replacement is performed when:

deforming arthrosis of the hip joint or coxarthrosis of 3-4 degrees, most typical for people of the older age category;
degenerative-dystrophic changes in the hip joint against the background of rheumatoid or other similar systemic diseases;
femoral neck fracture;
neoplasms that have arisen in the area of the femoral head and acetabulum, requiring emergency removal;
congenital or acquired hip dysplasia;
aseptic necrosis of the femoral head, which can be a complication of degenerative changes in the joint or occur in isolation and then lead to the development of coxarthrosis.

In case of a hip fracture, especially in older people, endoprosthesis replacement is performed urgently, bypassing the stage of conservative treatment.

Types and progress of hip replacement

The tactics of the operation and the type of endoprosthesis are selected based on the nature of the damage to the hip joint. Even the endoprostheses themselves exist in different types. Thus, total endoprosthetics can be performed with a complete replacement of the hip joint or partial with the replacement of only the femoral head with an artificial prosthesis, etc.

Hip replacement takes on average 50-60 minutes. In most cases, the operation is performed under epidural or spinal anesthesia, although general anesthesia can also be used. In general, the essence of endoprosthetics can be reflected as follows:

the patient is put under anesthesia using the chosen method and placed on his side on an orthopedic table;
perform a longitudinal oblique incision along the intertrochanteric line 6-10 cm long;
cut off the anterior part of the gluteus medius muscle from the greater trochanter of the femur and dissect the joint capsule;
the head of the femur is removed from the acetabulum;
resection and removal of the femoral neck is performed;
using hemispherical cutters, the acetabulum is cleaned down to cancellous bone and a press-fit cup is inserted, as well as an individually selected type of liner (for total endoprosthetics);
the end of the femur is brought out into the incision and a channel is formed in it for a seat for the wedge-shaped leg of the endoprosthesis (the size of the created channel must exactly match the size of the prosthesis leg, so its formation requires especially close attention and skill);
the endoprosthesis leg is mounted into the femur;
The endoprosthesis is fitted and the range of motion is checked;
the head of the prosthesis is installed and adjusted into the preserved acetabulum or previously installed artificially;
The wound is thoroughly washed with an antiseptic solution;
the joint capsule, muscles, ligaments and skin are sutured in layers;
The postoperative wound is covered with a sterile bandage.

The endoprosthesis can be installed using cement or in a cementless manner. In the first case, the surgeon uses special medical cement, which hardens in a matter of minutes. Typically, this technique is used to replace hip joints in elderly patients and those with osteoporosis.

With cementless fixation, the surfaces of the installed endoprostheses are characterized by the presence of roughness. Thanks to this, they firmly fuse with the bones, which takes about 3 months. This is the technique that is used most often.

Once again, we emphasize that it is better to entrust hip replacement surgery to orthopedic surgeons at specialized centers. After all, this operation requires a high level of skill.

Rehabilitation after hip replacement surgery

Even endoprosthetics performed at the highest level without high-quality rehabilitation will not give a good result. The success of the operation and the patient’s quality of life largely depend on the careful adherence to medical recommendations in the postoperative period and in the future. The doctor determines the permissible level of physical activity and the nature of other necessary measures based on the timing and individual characteristics of the body. All patients are required to pay maximum attention to the recommendations of specialists and avoid unwanted types of activity, do not increase the intensity of exercise without the doctor’s permission, and immediately contact the clinic if undesirable changes occur, for example, pain, swelling of soft tissues or the appearance of a hematoma.

After hip replacement surgery, rehabilitation is aimed at:

complete elimination of the inflammatory process and pain in the joint area;
restoration of the normal functioning of the muscular-ligamentous complex, responsible for the coherence of movements of the femur and pelvic bones;
reliable fusion of endoprosthesis parts with bones;
eliminating the risk of complications.

In general, rehabilitation after hip replacement begins on the first day after surgery. It is always comprehensive and includes exercise therapy, physiotherapy, therapeutic massage, etc. Also, drug therapy is prescribed at first. But each stage of rehabilitation has its own characteristics and different treatment and rehabilitation measures are used, which the attending physician must introduce to the patient.

On average, recovery of the body after hip replacement surgery takes about 3 months, and performance returns on average after 10 weeks.

The following stages of rehabilitation after hip replacement are distinguished:

early – first 2-3 weeks;
late – from 2-3 to 10 weeks.

After the 10th week, a long-term period of rehabilitation and preparation of the body for life in an active motor mode and the opportunity to engage in active sports begins. But a full return to sports, if planned, is possible only after 6-7 months.

A gradual impact on the operated joint will allow you to avoid the development of complications, eliminate postoperative swelling and pain as soon as possible, and also develop the operated leg as fully as possible, achieving restoration of its functionality. Patients also need to undergo examinations by an orthopedist at scheduled times to monitor the quality of the recovery period. But if pain or other disorders occur, you should consult a doctor unscheduled.

During rehabilitation, discomfort will inevitably be present: somewhere there will be pain, aching, pulling. But if you scrupulously follow all medical recommendations, these negative changes will quickly pass.

Drug therapy

On the first day after endoprosthetics, drug therapy is indicated. As a rule, they are prescribed:

broad-spectrum antibiotics to avoid the development of infectious complications;
anticoagulants that reduce the risk of thrombosis;
NSAIDs that reduce the severity of postoperative pain and inflammation;
drugs that improve the functioning of the urinary tract;
medications that have a protective effect on the mucous membranes of the gastrointestinal tract to avoid the negative effects of NSAIDs on them;
calcium supplements that help accelerate the recovery of bone structures.

Patients also regularly undergo antiseptic wound treatment.

Physiotherapy

After endoprosthetics, all patients are advised to undergo courses of physiotherapeutic procedures. Traditionally prescribed:

electrophoresis is a method that allows you to deliver the necessary drugs directly to the required area through the action of a weak electric current;
UHF is a method of physiotherapy that involves exposing the hip joint area to a high-frequency electromagnetic field, which is associated with thermal effects and acceleration of inflammation, pain reduction and activation of microcirculation;
electromyostimulation - involves the action of weak electrical impulses that cause muscles to contract, which imitates their normal activity;

laser therapy – produces an anti-inflammatory effect and also helps reduce pain and swelling;
Ultrasound therapy is a method that involves the therapeutic effect of ultrasonic waves on tissue, which helps to activate blood and lymph flow, improve the synthesis of collagen and elastin, which has a positive effect on the condition of ligaments and tendons;
magnetotherapy is a hardware technique for stimulating microcirculation in soft tissues and accelerating healing processes;
mud therapy - a method based on the positive effect on the body of various substances contained in medicinal mud, etc.

These procedures have analgesic and anti-edematous effects. They help eliminate muscle spasms and activate blood circulation in the affected area, which increases the speed of metabolic processes and has a positive effect on the speed of recovery. Physiotherapy also helps improve muscle tone and strengthen ligaments.

Exercise therapy

Physical therapy is the basis of rehabilitation after hip replacement surgery. It has been convincingly proven that patients who are not overweight and lead a fairly active lifestyle within the framework of the loads recommended by the doctor recover much faster. But excessive loads, especially in the first time after surgery, can do a disservice. Therefore, it is extremely important to strictly follow the recommendations received from your doctor.

In general, exercise therapy is aimed at:

stimulation of blood circulation in the lower extremities;
rapid elimination of the inflammatory process, swelling, pain;
increasing muscle strength and range of motion in the hip joint;
correction of spinal statics;
prevention of postoperative complications and strengthening of the immune system.

For each patient, a physical therapy program is developed individually, taking into account the type of surgical intervention performed, the person’s age, the presence of concomitant diseases and a number of other factors. Therefore, each patient will undergo recovery according to his own program with the intensity correctly selected for each stage of rehabilitation.

The essence of exercise therapy is the systematic repeated performance of specific exercises with a gradual increase in the level of physical activity. This contributes to the systematic improvement of motor activity indicators, as well as the restoration of performance. But it is important to engage in exercise therapy not only during rehabilitation, i.e. 3 months, but also after the end of this period. After all, all well-deserved achievements need to be consolidated and preserved.

At the early stage of rehabilitation, exercise therapy is carried out under the supervision of an instructor, who helps to master the correct technique for performing each recommended exercise, correctly increase the load on the operated leg and monitor the quality of recovery. At the later stage of rehabilitation, you can study at home according to an individually designed program, but it will still be more effective to contact a specialized center and continue to study under the supervision of professionals.

In addition, this will provide the opportunity to exercise on special simulators, which will contribute to more complete and rapid rehabilitation. In particular, in specialized clinics involved in the recovery of patients after hip replacement, there are special suspension systems. They are devices that can be used to change the gravitational load on any part of the body. As a result, when performing physical exercises, muscle efforts will be redistributed, which will allow even the deepest muscles to be worked out efficiently.

Also at the late stage of rehabilitation, work on block exercise machines, an exercise bike and a treadmill is recommended. It is not rational to visit a gym or fitness club for these purposes, since it is impossible to independently control the permissible level of load, and trainers in such establishments do not have the proper qualifications to help patients after hip replacement surgery.

Massotherapy

Therapeutic massage is a mandatory component of the rehabilitation program. Manual therapy sessions help not only reduce pain and quickly eliminate swelling. They help to activate blood circulation, not only in the operated leg, but also in the healthy one.

All this will help maintain normal muscle tone in the lower extremities, get back on your feet faster and return to an active lifestyle. But therapeutic massage sessions begin only after acute pain has been eliminated.

During them, the specialist initially prepares the soft tissues for more active influences. Then he thoroughly kneads the muscles, which leads to active blood flow to the affected area, eliminating spasms and improving muscle tone in general. During a therapeutic massage, the joints are necessarily worked out, but working with the hip joint is possible only after the inflammatory process has been eliminated.

Advantages and disadvantages

Like any surgical intervention, hip replacement has its advantages and disadvantages. Thanks to innovative technologies, operations are increasingly being performed using minimally invasive methods, with minimal damage to the skin and underlying soft tissues. The postoperative suture after such an intervention is small. It heals quickly, leaving no scars or scars on the skin.

But the main “advantage” of endoprosthetics is the elimination of pain, swelling, and limited mobility that precede complete immobility. After surgery performed using a minimally invasive method, the patient’s recovery is much faster. What can be attributed to the disadvantages of endoprosthetics:

risk of postoperative complications;
long period of rehabilitation;
the need to replace the endoprosthesis after 10-15 years.

Another “minus” is the relatively high cost. After contacting regional authorities, the patient is put on a waiting list for free endoprosthetics. But the operation is in demand, and you have to wait a long time for a call. Therefore, many patients prefer to pay for the installation of an artificial joint themselves in clinics in Russia, the Czech Republic, and Israel.

Early stage of rehabilitation

After hip replacement surgery, the patient is transferred to the intensive care unit. Here, constant monitoring is carried out over the main indicators of the functioning of the body, which is mandatory when performing any surgical intervention. All patients are immediately prescribed drug therapy and begin exercise therapy. But at this stage, physical therapy consists exclusively of breathing exercises to eliminate the risk of developing congestion in the lungs and performing passive movements in the ankle and knee joints.

If there are no complications, a day later the patient is transferred to a regular ward. Here he will have to spend 2-3 weeks, during which the medical staff will provide clinical care and help the patient recover as fully as possible after the operation.

For the first 7 days, an acute reactive-inflammatory reaction is present in the hip joint area. Therefore, at first there will be postoperative pain, which is relieved through the use of NSAIDs. Also during this period, drug therapy will be carried out aimed at reducing the development of postoperative complications.

As a rule, pain and swelling disappear after the suture heals.

Already from 2-3 days after surgery, the patient is activated, although the mode of physical activity is very gentle. The day after the operation, you can get up and walk, but only for short distances and exclusively with the support of crutches or a walker under the supervision of an instructor. Also, exercise therapy classes begin from the first days of rehabilitation. At first, it is recommended to perform isometric exercises to contract the muscles of the lower extremities. This will help increase their tone, elasticity and firmness. The exercises are performed while lying on the bed. But it is extremely important to avoid any jerks or sudden movements. Subsequently, the intensity of the loads is gradually increased and new exercises are introduced.

Patients must be taught the rules of sitting, which include avoiding hip flexion more than 90°. In this case, you can sit for 15-20 minutes. When the patient lies down, a special anatomical cushion is placed between his legs. This is necessary to eliminate the possibility of crossing the legs, which negatively affects the condition of the replaced hip joint. You can only lie on your healthy side, and you are allowed to sleep on your back.

Initially, the main body weight is supported on the healthy leg. Support on the operated limb is added extremely carefully. This begins with a slight touch of the foot to the floor surface and gradually increases the degree of supporting load. Instructors help the patient learn to stand again, and then move on to exercise therapy. They consist of performing exercises to abduct the leg, bending the knee joint with tension in the gluteal muscles, controlled transfer of body weight from one leg to the other, etc.

From days 8 to 14, epithelization, contraction, and healing of the wound occur. At this time, they switch to a light-tonic regimen of physical activity. This means that the duration of walking is gradually increased.

At the early stage of rehabilitation, patients are shown ultrasound therapy and electrical myostimulation.

Reviews from experts

According to doctors, the vast majority of patients are satisfied with the results of surgical treatment. All functions of the hip joint are restored, and the limping, shortening of the limb, and limitations in abduction and internal rotation of the hip that are characteristic of its damage disappear. Further rehabilitation with a gradual increase in loads helps to put in order the previously atrophied muscles of the thigh, buttocks, and lower legs. After installation of the prosthesis, the likelihood of bilateral damage to the hip joint due to improper redistribution of loads is reduced.

Late stage of rehabilitation

From the moment the patient is discharged from the clinic where the hip replacement surgery was performed, the late stage of rehabilitation begins. You can go through it yourself, but it is better to go to a specialized medical institution and undergo rehabilitation under the supervision of specialists. In this case, you can not only count on the best effect from endoprosthetics, but also on the fastest possible recovery of the body.

With normal completion of the early stage of rehabilitation, starting from the 22nd day, daily walking is indicated. They should be done 3-4 times a day, and each should last about 30 minutes. Gradually, the duration of walks is increased, bringing the total walking time to 4 hours by the 3rd month of recovery.

While walking, you should carefully monitor your posture and gait, and avoid habitual adaptive postures and movements.

You can stop using crutches approximately 1.5-2 months after surgery. They are replaced with a cane, with which you should walk for another 1-2 weeks. But all these changes in the physical regime are carried out with the permission of the attending physician. However, older patients may take longer to recover from arthroplasty and may require support devices longer. The timing of abandonment of crutches and canes also depends on the method of fixation of the endoprosthesis used. When using cement technology, it is possible to give full weight-bearing to the operated leg after 1-1.5 months. If a cementless technique was chosen, then the joint can be fully loaded no earlier than after 2 months.

At this time, you can already return to driving a car. But patients must learn to drive correctly: first sit in the seat and only then pull up their legs.

At the later stage of rehabilitation, exercise therapy classes are also continued. At this time, physical therapy classes are increasingly expanding due to the introduction of new and more diverse types of movement. But all this is carried out only with the permission of the attending physician. Often, patients at this stage are recommended to perform leg extension exercises using a rubber band, as well as perform a number of others that actively involve the hip joint in the work.

In the later stages of rehabilitation, sanatorium-resort treatment is indicated.

AT HOME

While at home, you need to continue doing therapeutic exercises and follow the recommendations of your doctor. It is also necessary to monitor your health, since exacerbation of chronic diseases, acute infections, hypothermia, and overwork can lead to inflammation of the operated joint. If your body temperature increases, swelling of the operated joint, redness of the skin over it, or increased pain in the joint, you should immediately consult a doctor.

Also, take basic precautions at home. Wear low-heeled shoes, temporarily remove moving rugs and wires from the floor, walk carefully on wet surfaces, and try to prevent pets from getting under your feet. Do your homework as much as you can. Alternate the time of work, rest, and gymnastics. Try to go for walks with the help of relatives and friends.