Hip replacement surgery: who needs to do this operation, how much does it cost and how does it pass
Hip joint endoprosthetics is an operation that is performed with a pronounced impairment of its function: with its high wear and tear, and also with injuries. Who needs to undergo such an operation? How much can it cost? How is this surgery performed? For all these questions, you will find the answers in our article.
Quick jump to the sections of the article:
To whom the operation
is shown Myths about the
endoprosthetics Types of operation
What are the endoprostheses
How much does such an operation cost?
How is the procedure for joint replacement
How to live further after the operation?
To whom operation
is shown The operation for joint replacement is most often performed with such diseases and conditions as:
photo of hip joint prosthesis
deforming hip osteoarthrosis( coxarthrosis);
- aseptic necrosis of the head of the femur( ANGBK);
- hip dysplasia;
- consequences of traumatic hip joint injuries;
- fracture of the femoral neck.
Each diagnosis described above is not yet an absolute indication for the operation: in each specific case, this issue is resolved after a thorough examination and examination of the patient by the attending physician.
With regard to arthrosis of the hip joint, the operation of endoprosthetics( EP) is usually performed in advanced stages of the disease( at 2-3 degrees of the disease), as well as with persistent and severe joint pains, including at rest, with a decrease in which painkillersalready do not cope.
endoprosthetics There are common misconceptions about this operation, "thanks to" which many people treat preoperative operations with prejudice or do not accurately assess them. We will try to dispel these myths.
Myth # 1: this operation should be done only in the most extreme case
Many patients with arthrosis of the hip joint( coxarthrosis) postpone the endoprosthesis replacement until the last, intending to go through it only if they are completely deprived of the opportunity to walk. In fact, this is not the best strategy. Delaying the arrival to the surgeon, such a patient completely in vain continues to experience pain in the joint, which could be avoided by doing surgery earlier.
In addition, when a person with this disease does not rush to the operation of hip arthroplasty( which has long been needed), this tightening only worsens the course of the disease. At this time, the disease continues to adversely affect human health and is increasing every day, thereby extending the terms of rehabilitation and a return to a healthy life.
Myth number 2: for complete recovery it is enough to just undergo such an operation
metal stent and articular head of prosthesis
Actually this is far from the case. Coxarthrosis or other disease, because of which it is necessary to do such an operation - is a disease not only of the femur, but of the entire joint and even of the whole organism.
Due to the fact that the patient spares the sick leg and uses less of it, the muscles of the hip and joint ligaments become weaker, atrophy, the density of bone tissue decreases( that is, osteoporosis develops), and so on.
Therefore, a complex approach is required for recovery, when the operation follows a well-chosen program of rehabilitation, physical therapy, physiotherapy and other therapies that help the patient to get back on their feet and feel healthy again.
Myth # 3: the endoprosthesis can quickly fail, and then it will be necessary to repeat the entire procedure first
This also does not always correspond to reality. Since endoprosthetics of the hip joint is not an easy operation, all prostheses are made with the expectation of maximum durability and working capacity.
Prostheses are made of high-quality plastic, ceramic or metal, due to which the service life of the endoprosthesis is 15-20 years, and if everything is in order, after only this period, repeat the operation to replace the endoprosthesis. And in elderly patients, thanks to such a long period of operation of the prosthesis, repeated surgery often does not need to.
Types of arthroplasty
Currently, there are three types of this operation: the replacement of the hip joint( TC), the installation of a partial prosthesis and a complete( total) prosthesis.
Replacement of TC surfaces
With this type of surgical intervention, surgical intervention on the joint area is minimal( compared to other methods).From the acetabulum of the pelvic bone, the cartilaginous layer is removed, which is replaced by a special artificial articular bed.
As for the thigh bone, but its head is sharpened in a certain way, after which a special metal cap is worn on it. Due to such changes, the articular surfaces of bones are replaced by artificial surfaces, and the slip between these parts becomes close to ideal.
Complete and partial replacement of the hip
This operation affects more tissues, but it is also performed in more severe cases, when the procedure for replacing the joint surfaces is no longer sufficiently reliable.
With this kind of surgical intervention, the femoral head is no longer grinded, but completely removed. In addition, the neck of the femur is also partially removed, and instead of these removed tissues an artificial articular bed is installed and also an artificial analogue of the head of the femur with a metallic or ceramic articular surface.
A special pin penetrates the body of the bone, and thanks to this, the structure has high strength. How it looks, you can see in the picture.
Complete, or total, endoprosthetics
This operation is the most radical of all listed, but at the same time very effective. Its essence lies in the fact that it completely replaces the hip joint. With the pelvic bone, the remains of the cartilaginous tissue are removed, and a new - ceramic or metallic - articular bed is placed in its place.
The other part of the artificial joint consists of a metal pin of high strength, which is made of titanium, stainless steel or other metals, and an articular head, which can also be made of metal or of high-quality ceramics. The metal pin penetrates into the femur and is fixed there, ensuring the reliability and stability of the entire structure, and the head of the prosthesis is attached directly to it.
What are the types of
endoprosthesis photos of the
ceramic hip joint prosthesis? Because all people are different, with different sizes and complexes, all the components of such an artificial endoprosthesis - pin, joint head, articular bed - are selected individually for each patient. There are about two hundred different components of this prosthesis. They are selected by the doctor in the process of examining the patient and preparing him for such an operation.
In addition, endoprostheses are made of different materials - metal, ceramics and high-quality plastic( polyethylene).Depending on the patient, the age and manner of life of the endoprosthesis operation, these materials can be combined with each other in various combinations.
So, for the elderly patient, who has little physical exertion on his leg, prostheses can be installed in which one part of the joint - for example, the articular bed - is made of plastic and the other is made of metal. This combination allows you to greatly increase the life of the endoprosthesis.
And if the operation is carried out by a young patient who has physical load on the joints( and will be in the future) sufficiently large, then the strategy of choosing a prosthesis will be completely different. Such a patient usually stops an endoprosthesis, in which both composite surfaces are made of ceramics, or both parts are made of metal. Such hip joint prostheses will be more rigid, but at the same time they can last for a long time even at high physical exertion on their feet.
How much does such an operation cost?
The cost of hip replacement consists of two components: the cost of the prosthesis itself and the cost of the operation together with the stay in the hospital.
The price of the endoprosthesis may vary depending on the disease: for example, an endoprosthesis for surgical treatment of coxarthrosis may cost more, even the prosthesis that is required, for example, for hip fractures and other diseases.
In general, the cost of a joint prosthesis ranges from 30-40 to 100 thousand rubles or more( on average in Moscow at the beginning of 2013).The cost of the operation itself, together with hospital stay, rehabilitation, etc.is between 20 and 70 thousand rubles and more.
Thus, the cost of an all-inclusive operation( we are talking about primary total endoprosthetics) can range from 50,000 to 350,000 rubles - when performing such surgical treatment in clinics and hospitals in Moscow.
If you do not trust domestic specialists, you can undergo similar surgery in medical institutions of other countries - Turkey( from 10,000 to 15,000 euros), Israel( from 15,000 to 20,000 euros) or in Germany( from 17,000 to 23,000 euros).
How is the operation
The duration of the operation is usually from 45 minutes to 3 hours. Depending on what kind of endoprosthetics is performed - total or partial - the duration of the procedure may vary. The operation is carried out under both general anesthesia and under spinal anesthesia.
For the patient to be able to start using the joint in full as soon as possible, very easy exercises of therapeutic gymnastics for the hip joint, which gradually complicate and increase the load on the operated leg, begin to be performed already 1-3 days after the operation. As a rule, a day after the operation the patient can already sit on the bed.
Usually 1-2 weeks after endoprosthetics, if everything went without complications, the patient is discharged from the hospital. By this time, he can already get out of bed and begin to walk neatly, and is also able to climb and descend the stairs with the help of crutches.
How to live further after the operation?
Of course, an extract from the hospital does not mean that treatment and rehabilitation is stopped at the same time. The attending physician prepares a rehabilitation program for the patient, consisting of several stages, during which the patient, as it were, learns to walk and use the new joint, learn to move and restore the load on his legs.
In this case, a return to the usual life for the patient with a full load usually occurs after 2-3 months - provided that he follows all the recommendations of the doctor. In some cases, including the elderly patient, the period of restoration of the joint function in full can take up to six months.
Read also patient feedback on hip arthroplasty.
Endoprosthetics of the hip joint. Operation and rehabilitation of hip arthroplasty
Indications for surgery for hip replacement
The main indications for operation of hip replacement are patient complaints and clinical x-ray examination data. Complaints of the patient in many respects determine indications for endoprosthetics of joints, in contrast to the diagnosis and stage of the disease.
If the patient feels great, but at the same time radiographically he has 3-4 st.coxarthrosis, he does not make complaints - such a patient does not need surgical treatment.
Operation of hip arthroplasty
Two brigades, anesthesia and surgery, are participating in the operation of hip arthroplasty. The operating team includes an operating surgeon and 2 assistants with two operation sisters. An anesthetist and an anesthesiologist work as part of the anesthesia team.Radiographs of a patient with dysplastic coxarthrosis, before and after surgery for total hip arthroplasty with a cementless prosthesis, ceramic-ceramic friction pair.
The standard case of artificial joint implantation takes 1.5-2 hours. The entire period of operation for hip arthroplasty is under anesthesia or spinal anesthesia .In order to prevent infectious complications, an antibiotic is injected intravenously, if necessary, blood is poured or drugs replacing it.
Surgery for hip arthroplasty is free of charge within the framework of the
VMP. For medical indications and availability of quotas for referral in our center, operations are performed at the expense of funds allocated under the high-tech medical care program(
). Details on the high-tech medical care program
Rehabilitation after endoprostheticship joint
After the operation, the patient is transferred to the for some time in the intensive care unit for further examinationjudgments. Injection of antibiotics and drugs that prevent blood clotting, lasts 7 days. Between the legs is installed a pillow, which keeps the legs at a certain distance from each other - in the position of the lead.
The ability to move in bed is allowed after the first day of the operation. It is allowed to sit down in bed, do respiratory gymnastics, and perform simple exercises for muscles .Movement on legs with the help of an instructor is possible from the third day after the operation, walking is carried out using crutches. Sutures are removed on the 10th -12th day after the operation.
An extract of the home is usually made after 10-12 days. Returning, it is worth continuing rehabilitation activities, following all the necessary recommendations. If there is a need, then you can continue recovery in the center under the guidance of a trauma doctor.
Household recommendations for patients
At home, several rules should be followed to reduce the risk of all possible complications:
- Do not allow full( or more than a right angle) flexion in the hip joint.
Observe the 4 rules:
- when you sit, your knees should be below the level of the hips, for this, put the pillow on the chair;
- do not cross your legs either in a sitting or lying position;
- do not lean forward, always get up with a straight even back;
- sit on a chair, slightly placing your legs.
- Follow the doctor's recommended mode of movement on crutches;
- Climbing and going down the stairs, stick to the railing;
- Use shoes with a non-slip sole and low heel;
- When visiting a doctor, be sure to say that you have an artificial joint;
- Do not hesitate to contact your surgeon if you have pain in the area after surgery or the overall body temperature has increased.
Of course, most of these recommendations are not life-long, but only last 6-8 months after the operation.
Remember the prosthesis
Do not forget that the endoprosthesis is not eternal. Like any other mechanism, it is inherent in wear. The service life of the prosthesis can reach 15 years.
The wear rate of a prosthesis is largely determined by the patient's own operating conditions. Do not lift the weight and engage in active sports.
It is not recommended to practice sports such as tennis, skiing, etc. Swimming or walking is allowed. It is important not to forget to watch your own weight.
Video calls for surgical treatment of hip fractureYurkov Victor endoprosthetics of the femoral neck Gorbunov AE66 years - endoprosthetics of the femoral neck
It is necessary to install an endoprosthesis replacing the hip joint after injuries, fractures and in the presence of other severe pathologies.
It should be noted that endoprosthetics, for example, in Germany is carried out according to the following indications:
- Congenital dislocation of the neck of the thigh.
- Osteoarthritis and severe osteoarthritis.
- Disease of Perthes, Bechterew.
- Tumor processes in the hip joint.
When considering the operation of endoprosthetics, other factors are taken into account, such as the general condition of the person, concomitant pathologies, the degree of damage to the operated area and the entire hip joint.
In addition, like any manipulation, this operation also has contraindications. The endoprosthesis should not be placed if there is:
- Presence of an infection in the body.
- Cardiovascular diseases.
- Severe renal and hepatic insufficiency.
Before the endoprosthesis replacement for hip replacement in Germany, Israel or another country, examinations( laboratory-instrumental), the patient are consulted by specialists. Possible correction of the state of drugs and physiotherapy before surgery and joint replacement.
Types of endoprosthetics
Endoprosthetics and replacement of a damaged hip joint can be carried out in two ways:
- Single-pole substitution - replacement of only the hip component, instead of it a prosthetic foot is installed. With this type of endoprosthesis, the acetabulum remains untouched.
- Complete joint replacement when all parts of the hip joint completely replace the endoprosthesis.
Stages of operation
As with any surgery, some complications of
are possible after endoprosthetics. At the first stage of preparation for endoprosthetics, consultation with the attending physician and surgeon is necessary. This is necessary to determine contraindications, if any. You should also take an X-ray, which will show how affected and worn the hip joint is.
The next step is to take all the tests and diagnose. Hospitalization is carried out a couple of days before the operation.
The procedure is as follows: a prosthetic leg is inserted into the center of the femur, it will be inserted in place of the neck of the hip, then a head with a liner is inserted, thanks to which the leg can move. After repositioning the head, the surgeon checks the length of the limb, selects the endoprosthesis of the required length and dimensions and installs it. The prosthesis is fixed using a special bone cement, which grows to the bone. As a result, the incision, where the prosthesis was, is washed with a special antiseptic substance and all the tissues are sutured along layers. On the upper layer of the skin are installed special staples. Perhaps the person will be interested in the very process of such a procedure. On the Internet you can see the video and photo operations. How long the procedure lasts depends on the specialists, in general, it takes about an hour.
The procedure for the replacement of the hip joint in Israel, Germany, Russia takes into account the anatomical structure of the operated area. Intervention requires general or epidural anesthesia. The incision is small, and the implants themselves are made of durable material. After the operation, for example in Germany, the patient is in the clinic for another week, he is observed by specialists, since the new artificial hip joint should take root.
As with any intervention, endoprosthetics may have complications. These include:
- Dislocation of the femoral neck - such complications occur when the globular head of the prosthesis moves away from the acetabulum.
- Infectious complications.
- Damage to the blood vessels and nerves of nearby tissues.
- Complications associated with intubation in anesthesia( eg, pneumonia).
To avoid the development of complications, it is important to quit smoking and not take alcohol, fight excess weight, if such a problem exists, treat all foci of infection in the body.
intervention After a surgical intervention, a rehabilitation period begins. The patient is discharged in Russia a few days after the intervention, in Germany, strictly after a week. This is an inadequate period for the restoration of a new joint to be complete. The duration of the process depends on many factors, one of which is the presence of possible complications.
Rehabilitation period after surgery can be quite long
Dependence on previous pathology is traced:
- If there was a neck fracture, then the time through which the prosthesis was inserted is important. When the time passed not so much, the muscles are included in the work quickly enough.
- If prosthetics were several years later, the atrophied muscular skeleton needs more time to again fully fulfill its function.
- If a person has suffered pain for years, the cartilage and bone wear out, the muscles atrophy, and the replacement is done "at the last minute," then rehabilitation can take quite a long time.
An extract after joint replacement is carried out in a week. In Russian medical institutions, patients can be discharged within a few days. But this does not mean that the body has recovered. How much time will take the recovery period, directly depends on many factors, including the possibility of complications.
It is important to take into account the pathology due to which the joint was made:
- If the bones and cartilage are worn out, the muscles are atrophied, after the prosthesis has been carried out, the rehabilitation period can take a long time.
- Prosthesis after fracture depends on how quickly the operation was performed. The sooner, the sooner the muscles adapt.
- If prosthetics were performed a few years after the injury, it will take a long time to fully adapt the muscle framework to the prosthesis.
Either way, the body of each patient is individual, and it also matters in the duration of the recovery period.
endoprosthetics Fortunately, to perform prosthetics, you do not need to go to Germany or anywhere else. In Russia, such a procedure is conducted in Moscow on a quota paid by the state. It is worth noting that the replacement of the joint is very expensive. For example, in Germany the price of a hip replacement is from 10,000 dollars. In addition, you will need to pay for a place in the ward, tests and so on. As a result, the cost will be about 20,000 dollars. Rehabilitation after the replacement of TBS is also expensive.
To operate on a quota is not an easy task. First, you need to issue the quota itself, and then you need to apply to the hospital with a coupon for high-tech assistance( VMP ticket).Your data is placed in the queue for an operation of endoprosthetics for the current year. The expectation in Moscow takes an average of about six months, it should be taken into account in its plans.
How much will the prosthetics cost, depends primarily on the material from which the prosthesis is made, the clinics where the operation is performed. The price of the operation depends on the doctor's qualifications, patient care, placement in the ward and patient care, depending on how much he will be in the institution. Before the operation, doctors discuss all these nuances, and also show the patient in the photo how the new limb looks from the inside. The photo will help the patient to accurately understand what kind of appearance will be at the joint from the inside.
Table 1. Prices for the operation for the replacement of the hip joint
Who has had the operation to replace the hip? Please share how everything went, the consequences and where the
I have two ladies that have been known to change, many years have passed,everything is normal with them. Did or made in Moscow, precisely where I do not know. Of course we went on crutches for a long time after the operation.
^ _ ^ LiLiT ^ _ ^
My friend suffered an operation in this nightmarish summer, In the very heat. Generally, in civilized countries, in hot weather, they do not operate, if not urgently. Received a quota. The operation is rather complicated, because it is repeated., now feels well and walks already without a wand. It is happy, is going to do on the second joint. Joints are now very good, there are even sports, that is, for large loads. Did or made in Moscow, clinic I can specify, if it is necessary.
Luda M Ezentseva
I just can advise you clinic- and you can read on the Internet for a doctor from God( moderate prices) I personally was operated there( removal of ossicles on the leg) which is engaged in operating-I will give you links and you read-if you need I will give youphone, there in the hospital everything is so professional, it's fine-every Saturday consultation is shorter if you are not far to go then it's better than the option for you not to go
Stinsky Boris Vladimirovich- orthopedic physician in Yenakiyevo
[link blocked by decision of the project administration]
[link blockageI was commissioned by the project administration]
my mother 2 years ago did - very satisfied
was operated in Chelyabinsk - in the ambulance - everything went well, half an operation for 2 days you can walk on crutches, write out for 10day - but only then it will be 2-3 months to be like crutches and to do special gymnastics for the development of the foot and most importantly to get money for the operation, as for IPR these operations are far from being paid by everyone.
They sent a friend to Singapore. I was very pleased. The operation was successful. And the price was acceptable. If interested, go to our website, there information about the doctor and the operation.[link is blocked by the decision of the project administration]
My mom moved in 2008.I was practically in my arms. A lot of things I can tell. Nol is primarily interested in specific questions: how many years the patient( potential), what health, pressure, heart. Where the operation is supposed to. ..Much depends on this.
Mom did in the summer, in the hospital, a total of 27 days( she is 71 years old), then - nadom. At first, even in the hospital, she began to walk on crutches - with a coach. She was explained how to properly distribute the load on her leg, then taught with a stick to walk. After 2 full months on arrival, I started walking without a stick. Still. There are many important nuances( for example, you can not shake your legs, it is advisable to sleep on your side with a pillow between your legs, when the hardest "recumbent" period is to carefully monitor the formation of decubitus, give the patient to inflate balloons( to avoid stagnation in the lungs), etc.etc.