Rehabilitation after endoprosthetics

Restoration after hip arthroplasty

More recently, many patients with hip arthrosis( coxarthrosis) or fractured femoral neck were doomed to complete disability due to loss of ability to move independently. Fortunately, the introduction of new technologies in medicine has allowed patients to avoid this fate, and to live up to their previous full life. One of these technologies is total hip replacement( TETS), when the entire hip joint( head, neck of the hip, cartilage surface of the acetabulum) is replaced with a synthetic prosthesis. But in order for the synthetic joint to work just as well as "the native one", it is important not only to carry out the operation at a class level. It requires competent postoperative recovery or rehabilitation after endoprosthetics. And it depends not only on the doctor, but also on the patient.

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Suprapatellar bursitis of the knee joint

TETS itself is a rather complicated technical and traumatic operation. The skin and muscles are dissected, the bone-cartilaginous tissues of the worn out joint are removed. Then the leg of the prosthesis is fixed in the canal of the femur. Severe operating injury is accompanied by pain, the release of biologically active substances from tissues to the blood. In turn, this leads to a change in the functioning of the heart, lungs, coagulating blood system. Preoperative preparation and anesthesia eliminate all these negative consequences, but only to a certain extent.

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It goes without saying that people go to endoprosthetics, to put it mildly, not from a good life. Strict indications are needed for such an operation. Such indications include the destruction of joint structures due to coxarthrosis or hip fracture. With coxarthrosis, due to long-term motor disorders, atrophic changes in the muscles of the lower limb and back are developed, and the work of the pelvic organs is disrupted. The load on the spine increases, which leads to the development of lumbosacral osteochondrosis and radiculitis.

Do not forget that the vast majority of patients operated on for TETS are elderly and senile. This means that they have varying degrees of disability in the functions of the heart, respiration, and endocrine system. In some patients, the disorders are decompensated, and after the operation are aggravated. In addition, the operation itself and the postoperative bed regimen lead to disruption of the peristalsis( contractions) of the intestine until the development of atonic intestinal obstruction. It should not be forgotten that in the elderly, the ability to regenerate, heal damaged tissues during surgery, is significantly reduced. Immunity is weakened, resulting in favorable conditions for infection.

Thus, postoperative problems after hip replacement are as follows:

  • Patient worried about postoperative pain
  • Exacerbated atrophy of muscles
  • Cardiopulmonary insufficiency worsened
  • Bowel function disrupted
  • Great risk of cerebral strokes due to blood pressure jumps
  • Blood clotting disorders maylead to thrombosis of the veins of the lower extremities and to an extremely serious condition - pulmonary embolism of the
  • PosleAn operative wound can serve as an entrance gate for infection.

The main directions of rehabilitation

Measures to restore motor functions and prevent postoperative complications are complex. Needless to say, the main emphasis is on curative physical training( LFK), which is designed to ensure the optimal operation of the newly acquired joint and the entire lower limb. In addition to exercise therapy, other therapeutic measures are carried out using drugs from different groups, as well as physiotherapy procedures.

And the first such action is postoperative analgesia, during which they combine non-narcotic( Renalgan, Dexalgin) and narcotic( Morphine, Promedol) funds. To prevent severe pulmonary heart failure, patients are prescribed cardiac remedies( Mildronate, Riboxin, ATP).This patient shows inhalation( inhalation) of oxygen. Oxygen in a moistened form is fed through a special breathing apparatus.

Another important point is the prevention of thrombotic complications, which often develop in patients in the elderly after surgery. At the same time, in the veins of the lower extremities, the parietal thrombi form, which, when detached, are brought into the pulmonary artery by the blood stream and clog it. Blockage of the main trunk of the pulmonary artery can cause instant death. To prevent this from happening, in the first few days after the operation, such patients are bandaged with an elastic bandage and subcutaneously injected with funds preventing blood clotting( Fraksiparin, Clexan).To eliminate postoperative atony of the intestine, assign injections of Proserin, Ubretid. Necessarily prescribe antibiotics( Ceftriaxone, Metrogil).

Principles of exercise therapy

There is a misconception that exercise therapy after hip arthroplasty can be performed only in the late postoperative period, and in the early days you need a strict rest. This erroneous tactic can lead to contractures( persistent limitations of the volume of movements) and to thrombotic complications. Therefore, some, the most simple loads, are carried out already in the first day after the operation, on leaving the anesthesia. In the exercise of exercise therapy should be observed the principle of phase, when the exercises themselves are done in several phases.

Zero phase

Zero phase - in the first day after the operation, when the following types of exercises are performed:

  • Bringing and lifting the foot up and down several times every 10 minutes.- The so-called.foot pump
  • Ankle rotation in both directions 5 times
  • Short-term, for 10 min, the tension of the anterior quadriceps femoris
  • Knee flexion with simultaneous pulling of the heel
  • Cuts of the buttocks with subsequent tension for 5 seconds
  • Retreatment of the operated leg to the side and returnin the starting position
  • Raising the straightened leg for a few seconds.

First phase of

The first phase, 1-4 days after surgery - the so-called.strict care. At this time, you are allowed to sit on a hospital bed or chair, and then move with crutches or special walkers. Important: when planting, do not bend the limb in the hip joint more than 900, do not cross the legs. On the contrary, lying on the bed, try to take your foot to the side. For this, you can put a pillow between your legs. The main types of exercises in this phase are performed in the standing position:

  • Leg bending in the knee and hip joints
  • Straightening of the leg in the hip joint and drawing it back
  • Retracting the leg to the side.

The second phase of

The second phase of rehabilitation or deceptive opportunities - 5 days - 3 weeks after the operation. Many patients at this time feel a surge of energy, they were tired of stiffness and inaction. But the joint is not yet strong, and muscle atrophy persists. This phase shows the movement loads - movement on a horizontal surface, but not more than 100-150 m.or climbing and descending the stairs. Climbing the stairs, you should lean on a cane or on a crutch. At the same time, at the higher step, first put a healthy leg, then operated on, and then - a cane. When descending the stairs, everything is done in the reverse order.

The third phase of

The third phase of rehabilitation, the "beginning of work" - after 1-2 months.after operation. At this time, the implanted joint "caught on", and the muscles and ligaments are so strong that you can smoothly increase the load, and carry them out at home. Exercises in this period are similar to the previous ones, but they are performed with burdening. As a weigher, an elastic band can be used. One end of the tape is tied to the operated leg at the ankle level, and the other to the fixed object, for example, to the door handle, followed by bending, straightening and retraction.

During this period, you can increase the duration of walking tours - for half an hour 3-4 times a day. Even exercises on a stationary bike are shown. In this case, do not forget one rule - the emergence of pain is a signal to stop training. At the same time, do not stay for more than an hour, sit in a fixed position. The above rule of the right angle must also be observed. In general, during each hour should be a little, for several minutes, walk around.

In the course of rehabilitation after endoprosthetics, the exercise therapy necessarily combines with physiotherapeutic procedures, among them - darsonval, phonophoresis, magnet, amplipulse. Thanks to these procedures, the edema is finally eliminated, the muscles are stimulated. The final stage of rehabilitation of hip arthroplasty is a stay at mud resorts.

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Rehabilitation after hip arthroplasty - Sustavy-Bezboli.ru

In the recent past, patients who had a hip fracture or suffered from hip arthrosis lost the ability to move independently. But, thanks to modern technology, now they can feel like everyone else and live a full life. This is possible thanks to a new technology, which has the name - total hip replacement.

Carrying out this procedure allows you to replace the entire hip joint, namely: the cartilage surface of the acetabulum, the neck of the hip and the head on the prosthesis made of synthetics. But a favorable prognosis of the operation depends largely on the patient, since it is important not only the correct operation, but also effective rehabilitation rehabilitation.

The operation of endoprosthetics is rather traumatic and difficult in technical terms. To conduct it, you need to cut the muscles and skin of the thigh, remove the bone-cartilaginous tissue. After this, the prosthesis should be fixed in the canal of the femur. During surgical intervention, the lungs, heart and blood coagulation system are disrupted.

Reasons for recommended endoprosthetics

According to clinical signs, there are reasons for recommending endoprosthetics:

  1. The presence of arthrosis is a lesion of the hip joint cartilage. This pathology most often manifests itself in old age and is provoked by the natural wear of the cartilage. Manifestations of this disease are: decreased mobility of the joint and its soreness. Also provoke the appearance of arthrosis may be incorrectly fused bones, after fractures or incorrect development of the joint.
  2. Fracture of the neck of the hip is a particularly dangerous disease in the elderly, as there is a high probability that the bones will not grow together.
  3. Arthritis is a joint disease in which severe inflammation is common.

A little about endoprosthetics

Specialists do not have a certain technique according to the rehabilitation period. This is due to the fact that the rehabilitation depends on the reasons that provoked the prosthesis.

With a fracture of the neck of the hip, prosthetics should be performed better, as soon as possible( after the fracture, the muscles did not lose their tone and functionality).

If the operative intervention is carried out through a long period of the disease( the patient has experienced pain for a long time, does not load the joint), the rehabilitation process will take a longer period. If the arthrosis on time to carry out endoprosthetics, it will shorten the recovery process.

The majority of patients used by TETS( total hip arthroplasty) are elderly people. Proceeding from this, we can say that they have problems with the work of the endocrine system, breathing and heart. In some cases, after the operation, such violations are only aggravated.

Operational and postoperative periods are long enough and can lead to the fact that the patient develops a violation of intestinal peristalsis. It is also worth remembering that in the elderly, immunity is reduced, the body's ability to regenerate, this has a beneficial effect on the penetration of pathogenic microorganisms into the body.

Postoperative problems

After the surgical intervention, the patient will face such problems:

  • Disruption of the intestine;
  • An unstable blood pressure level can lead to a stroke;
  • Muscular atrophy develops;
  • Bacteria can enter the wound;
  • Exacerbation of cardiopulmonary insufficiency;
  • Disrupted blood clotting can lead to pulmonary embolism or thrombosis of the veins of the lower limbs.

Endoprosthetics: rehabilitation periods

It is customary to distinguish several recovery periods:

  • Early;
  • Remote.

A bit about the early period of

This period begins immediately after surgery, when the patient is transferred to the intensive care unit. The leg is placed with a slight lead to the side, the platen is placed under the knee joint, so that the operated one can move the foot. During this period it is recommended to actively and often move the foot and, in order to avoid stagnation in the lungs, to carry out respiratory gymnastics.

From the third day after the operation, the patient can become crutches, if he does it confidently, then from 4-5 days you can gradually begin to move( only under the supervision of a doctor).

On the operated leg, it is desirable to increase the load gradually. It is also recommended to carry out physical exercises. The complex of exercises is appointed only by the treating specialist and especially individually. After discharge, it is recommended that about 1 month not go to sleep on a sore leg and use crutches for at least 2 months for walking.

Late

After discharge, the exercises prescribed by the doctor are mandatory. During 2-3 months it is not recommended to conduct low squats, circular movements, sharp turns during walking.

On the 3rd month of rehabilitation you can go on walking with a cane. It is also desirable to attend monthly sessions of massage with an emphasis on the lumbar region. The load on the joint during walking should be increased gradually. Movements need to start several times a day, and gradually increase their number.

During rest you need to lie on your back with a roller between your legs. In the sitting position, the knee joint should be below the hip joint. Take a shower followed with someone's help. This period is particularly important, since it depends entirely on the patient himself.

Remote period

Three walking months after the operation, two walking sticks should be used for walking. Lameness should be absent( if you have it you need to restore the exercise complex).

After 6 months you can swim, and after 6 months you can ride a bicycle. Active sports, jumping, running are contraindicated.

Prevention

After the establishment of an artificial prosthesis, it is recommended to avoid catarrhal diseases. Since the joint contains metal, you should not overheat it. Excess weight will increase the load on the joint and accelerate the period of its wear. The diet should include many vitamins, proteins.

It is important to protect yourself from the development or aggravation of osteoporosis. To do this, do not abuse alcohol, smoking, lead an active lifestyle. From the diet should be eliminated carbonated drinks, and add fish, vegetables, dairy products.

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Rehabilitation after hip arthroplasty: make your new joint work

Hip replacement is an operation that solves the problem of reduced mobility andsoreness of the feet. However, even before the operation, doctors will warn you that in order to achieve a positive result, that is, a complete return to normal life, after the operation, a long rehabilitation will be required, the success of which will depend only on you.

Stages of rehabilitation after hip arthroplasty

After endoprosthetics of the hip joint, all are experiencing severe pain, the most comfortable position of the person in this case is inaction. But it's important to get out of this comfort zone and get yourself used to a new joint.

Rehabilitation after hip arthroplasty is divided into several periods. We will write down below 3 main periods.

Early period of

It occurs immediately after the operation. Its goal is to prevent complications. As soon as you wake up from anesthesia, you need to feel your feet. Periodically, move your fingers and try to bend them in your lap. Purposefully develop them, even through pain. However, at the same time listen to your body - do not try it too intensively. After all, complications even after successful hip replacement are not uncommon.

In addition to physical exercises, perform respiratory gymnastics - a deep breath and exhalation. This is necessary to restore the work of the respiratory system and the cardiovascular system, which inevitably suffer during the operation.

You will spend a couple of days after the operation in the intensive care unit, then you will be transferred to a separate ward, and the LFK instructor will be there with you. He will show a set of exercises that should be performed: lifting the legs, straining the muscles of the thigh, flexing the leg in the knee, pulling it aside. Your task is to do them at least two times a day before the appearance of fatigue.

In addition, in the early recovery period after hip replacement, it is important to ensure that the leg is not in one position for a long time. Periodically, place the platen under the knee joint and hold it for 20 minutes. And remember - the leg should always be in a slightly retracted state, and fingers should be directed upwards.

Get out of bed you will be allowed in 5-7 days. The doctor will help you for the first time, he will also instruct you about the use of crutches. Once you learn how to stand firm on crutches, you will be advised to take the first step. It is painful, but necessary.

Late period: rehabilitation after discharge from hospital( up to three months after surgery)

The duration of rehabilitation after hip replacement is not the same for everyone. It varies depending on age, health status and other factors. The task of this stage is to strengthen the muscles of the lower extremities and to master minimal walking skills with a new joint. To do this every day for several times you will have to perform simple exercises, which will show the doctor. And then there can be one problem: since you will already feel good, at some point you may think that the goal is achieved, the motor activity is restored, and now you can use your foot as usual. However, do not immediately after making such a decision to run a marathon. The load should be increased gradually. The first two months - no more than 30 minutes of walking a day. Razdrobite this 3-4 times, rest the rest, do not forget to put the roller to fix the foot in the allotted state.

In order not to overwork, dress seated. Socks and shoes will have to be worn with the help of someone, since the prosthesis can react strongly to excessive flexion. The same goes for getting objects from the floor. And forget for a while about physical work.

Remote period: rehabilitation three months after the operation

Because after the operation you will periodically see the doctor, then you will quickly find out about all the changes. So, if the doctor decides that the long-term rehabilitation period has come for you, it will mean that the load on the joint will become more serious and intense. The task of the third stage is the adaptation of the new joint to normal motor activity.

  • You will go from the crutches to the cane. It will be made for your growth. Walk with a cane will have at least 6 months, and then it should be kept at hand in case of fatigue.
  • You will be offered a different set of exercises. It will be possible to do half-squats with support and transfer the weight of the body to the operated leg.
  • You will be allowed to swim, ski and ride a bike. These actions well develop a new joint without causing undue stress.
  • You will be closed by a sick-list on condition that you do not perform heavy physical work.

However, you will still not be able to lean forward. This can be done in the last place - at the moment when the doctor will tell you that the joint is well designed and can be used intensively.

As you have probably realized, recovery after hip replacement is a long and responsible process. On how seriously you will treat him, the final result will depend - your return to normal life without pain in your legs.

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In the first two days after the operation for the replacement of the hip joint with a prosthesis, procedures of UHF or magnetotherapy with exposure to radiation and temperature on the seam area are shown. They relieve swelling, have an anti-inflammatory and analgesic effect( the procedure is carried out right in the ward without removing the bandage).If there are contraindications to these procedures, it is possible to carry out UV-irradiation of the wound at the moment of dressing.

To prevent stagnant phenomena in the lungs and the development of pneumonia in the initial period of rehabilitation, breathing exercises are performed, vibromassage of the thorax is prescribed. In the initial period of rehabilitation shows a course of exercise therapy, massage and active exercises for the joints of the limbs. The patient is taught isometric exercises( muscle strain of the diseased limb), which are performed for 1-5 seconds for the shin, thigh and buttock.

Post-operative gymnastics is performed daily for 15 minutes for 3-5 visits, this allows you to mobilize the central nervous system and strengthen the complex of metabolic-trophic processes in the muscles. This gymnastics is especially indicated for bilateral hip joint lesions.

4-8 day

Four days after the operation to replace the hip joint on the prosthesis, one must start learning to walk on the stairs in the houses, always leaning on the handrails and do not more than one step at a time.

To restore mobility of the operated limb after joint replacement, the LFK course and massage are shown.

Climbing the stairs in the house:

  • stepping up a healthy foot;
  • rearrange the operated leg on a step above;
  • put on a step a crutch / cane.

Descending the stairs in the house:

  • put the cane / crutch on the lower level;
  • to make a step down the operated leg;
  • put a healthy leg.

Climbing the stairs in the house always begins with a healthy leg, and descent - with the operated.4-5 day is not in vain called the phase of "deceptive opportunities", because severe pain and weakness in the leg to the 5th day passes, and the patient wants to fully feel the limb after the replacement of the joint on the prosthesis. Do not neglect the rules and start overloading your leg, otherwise you can get a dislocation of the hip joint.

2-3 weeks

In the period from 2 to 3 weeks after endoprosthetics( after the removal of stitches) the restoration program includes massage of the TBS zone, using non-rough massage techniques and without pain. The following exercise complex of exercise therapy is shown:

  • exercises for small joints of the limbs;
  • exercises for diaphragmatic and chest breathing;
  • sitting in bed with the help of hands.

Special attention should be given to laying and fixing with special rollers of the operated limb after endoprosthetics. The rollers are placed under the knee joint and from the outside to exclude the external rotation of the thigh.

4-8 week

In the period from 4 to 8 weeks it's time to increase the load on the muscles, train them, restore strength and balance of movements. This is necessary to "change" from the crutches to the cane. It is necessary to perform the following set of exercises, post-natal for the development of the muscles of the lower extremities and the hip joint:

  1. Classes with elastic band( resistance).Performed three times a day for 10 times. One end of the elastic band is attached around the ankle, the other - to any heavy furniture.
  2. Flexion in the hip( with resistance).Stand with your back to the wall, where an elastic band is attached, slightly set aside your leg. To lift it forward, the knee is straightened. Return to and.
  3. Legs in standing position. Stand up to the attached ribbon in a healthy side, the operated leg is taken to the side, return to and.etc.

During recovery after joint replacement, it is necessary to train with the help of special simulators

. Walk with a cane until you are sure of balance. Walking - daily for 5-10 minutes three times a day. Later, the time and the frequency of walking should be increased.

After endoprosthetics, simplified exercises on simulators are recommended( check with the trainer or watch special videos).It is best to practice on a conventional exercise bike, which is used to restore muscle strength and hip joint mobility after endoprosthetics. At the beginning of the pedal to turn only back, then - forward( do not raise the high knee), after about a month you can gradually increase the load. The exercise bike is important to be specially adjusted in accordance with the growth.

Late stage of

At the heart of the late rehabilitation period after the operation to replace the prosthesis is the passage of a health course within a specialized center or a sanatorium equipped with special equipment. Restorative treatment is selected individually for each patient, taking into account the characteristics of the body, the form and stage of the disease. The following complex of procedures for restoration can be used in the sanatorium:

  • Therapeutic massage - the actions of a manual specialist are aimed at restoring muscles and ligaments, relieving tension, improving blood flow, and removing pain.
  • Acupuncture - reduces pain after surgery, eliminates spasm of blood vessels, improves nutrition of tissues.
  • Physiotherapy - effect on the restoring area with the help of laser, ultrasound, temperature, electric current and other physical factors.
  • Gryazerapiya - curative mud contains active minerals that activate metabolic processes, improve the nutrition of tissues.
  • Hydrotherapy - you can use aqua aerobics, salt and coniferous baths of a certain temperature, shower-sharko, etc.

Replacement of a weaker load with a heavier load is allowed no earlier than 2-3 months, if the rules are not observed, complications may occur. Up to six months, it is recommended to carry out restorative measures at home: exercise gymnastics for 10-15 minutes a day, observe a special diet, drink medications prescribed by a doctor.

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