Rehabilitation after hip arthroplasty

When is hip replacement needed?

The hip joint( TBS) is not only the largest and heaviest joint of our SLM.It literally is vitally important, since with its inefficiency it is impossible even to stand on its feet, and not just to walk. Despite the complexity of hip replacement, it is often prescribed for vital signs. In this article we will consider:

  • When an operation is needed for the replacement of the hip
  • How the operation is performed and what contraindications to it
  • What you need to do after the endoprosthesis of the hip joint as long as possible is not needed a re-operation
  • What is the revision prosthesis

In somethe operation of joint replacement is vital

Hip replacement: pros and cons

Hip joint structure

  • TazobedrumThe joint connects the hip and pelvic bones and has a hinge structure:
  • The pelvic bone has an acetabular cavity in which the gluteal head
  • holds and rotates with the help of ligaments and muscles. The head is connected to the thigh itself with the neck at an angle of 125 - 145 углом
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  • The surfaces of the head and cavities are covered with a cartilage layer, both strong and elastic
  • The joint is closed with a capsule filled with synovial fluid
  • Uniform joint lubrication is provided by the acetabulum-elevationon the edges of the acetabulum

This perfect structure provides greater joint mobility, the possibility to make extensor and rotational movement of the wide amplitude.

Video: Anatomy of TBS

What can cause joint replacement

A number of diseases lead to the development of a hip joint resource:

Deformation and fractures in the joint often cause pain and restriction of movements in the TDS

  1. Deforming osteoarthritis, during which the :

    • cartilage graduallyerased and destroyed
    • volume of joint fluid decreases
    • the distance between the surface of the head and the acetabulum is shortened
    • movements in the joint are limited to
  2. VospaLenie TBS because of osteoarthritis plus systemic arthritis :

    • Rheumatoid and psoriatic arthritis
    • Ankylosing spondylitis
    • lupus erythematosus
  3. Congenital dysplasia :

    • Dislocation TBS
    • Underdevelopment acetabulum
  4. Aseptic necrosis of head :

    arises due to circulatory disorders, such as, when squeezing or rupturing blood vessels that feed the head of the thigh. Usually this occurs with

  5. injury. fracture of femur neck:

    Often complication of osteoporosis to old age, resulting in painful pain, complete disability and premature death.

When TDS is needed for replacement of

. Replacement of TBS for arthrosis and arthritis.

. No joint replacement for arthrosis or arthritis, if there is an opportunity to treat it conservatively, doing gymnastics, changing the whole system of nutrition and losing excess weight

Such methods, although not liquidate irreversible changedin the joint itself, but it is possible, using the body's own compensatory capabilities, to maintain physical activity for a very long time, even at a late stage of arthrosis.

Actual surgery becomes the fourth stage of ankylosis.

Endoprosthetics for dysplasia

In congenital dysplasia, the relationship to endoprosthetics is quite different. It can be considered here as the only opportunity to give the child a different future. Therefore, if there are no serious contraindications, then of course, the operation should be carried out as early as possible .

Fracture of the cervical rib and joint replacement

With a hip fracture in old age, endoprosthetics becomes the only salvation, since the elderly immobilized person dies very quickly due to any complications: pneumonia, thrombosis, pressure sores, etc.

Fracture of the femoral neck in old age leads to a critical situation

  • Splicing of the neck of the hip becomes impossible due to damaged vessels and developing osteonecrosis
  • Even if the vessels are not damaged and the fracture line is horizontal,for osteoporosis will be extremely slow and it will be difficult to restore the joint.

    How is the operation

    The essence of the operation in the articulation of the joint bones, the successive selection of the leg and the cup and their subsequent fastening

    Cement mounting method

    • The template is produced by the sawdust of the neck and the femoral head
    • The femoral canal
    • is drilled.increasing the size of the rasp until the last one is sitting firmly
    • Put the head on the rasp and check how the joint moves
    • After selecting the stem and the head, the canal in the bone is drownedstopper and syringe fill it with glue
    • Put the centralizer on the end of the foot, inject it into the liquid glue
    • After five to eight minutes, remove the excess cement

    The cementless method of fixing

    Produce all the same operations, only the selected foot is pinned to the channel until the jam is completely sealed.

    Replacement of the hip joint in both cases is performed under regional spinal anesthesia .

    Video: Surgery to replace TBA

    In what diseases is it impossible to endoprosthetics

    The following diseases can prevent the operation:

    • Diabetes of the primary and secondary type
    • Incontinence or bad blood coagulation
    • Hypertensive crisis
    • Recently experienced infarction or stroke
    • Acute blood leukemia
    • Exacerbation of systemic arthritis,bone tuberculosis, osteomyelitis
    • Exacerbation of chronic diseases
    • Bone metastases in stage 4 of cancer

    About the preparation for surgery andnecessary research, the first steps to restore read the article Endoprosthesis of the knee

    When the contraindication is lazy

    If you are suffering from pain in the TBS and the limitations of your freedom of movement, but you are lazy, afraid of exercise, then do not think that the operation will be an easy way out.

    After endoprosthetics of the hip joint, an intensive rehabilitation program will be needed immediately on the second day, without any self-pity.

    As a rule, osteoarthritis develops faster with muscular-ligamentous atrophy. If you can not strengthen your muscles and ligaments before the surgery, preparing them for future rehabilitation, then it is hardly worth counting on the success of endoprosthetics

    Contraindications - old age illnesses

    The contradiction of the elderly - the rehabilitation of the elderly person should be even more active than in young,and with an early full load to stimulate blood supply, healing and to prevent complications

    All this also does not fit into the usual recovery scheme after complex surgical operations.

    And another vicious circle. .. Yes, endoprosthetics can be critically needed, but

    • What if an elderly patient has contraindications-a whole bunch of serious diseases:
      heart failure, diabetes, thrombophlebitis, etc. .?
    • If he suffered a recent heart attack or stroke?
      And this, unfortunately, is more the norm in old age than the exception. ..
    • How will osteoporosis with the endoprosthesis be tolerated:
      • Will not further destruction go?(often in the elderly, because of the head of the endoprosthesis, the edges of the acetabulum are destroyed)
      • Will the prosthesis itself survive?

    These contraindications can put an end to endoprosthetics, and then they often hope for the formation of a false joint during fusion.

    What is the solution for the elderly?

    In the figure to the left - an ordinary leg, touching at three points in the bone channel.
    The figure on the right shows a leg that repeats the anatomical contour of the femur canal

    Thus, replacing the hip joint in old age causes more than enough questions.

    The choice of the material, the constructive appearance of the prosthesis foot is extremely important.

    For the types of dentures and materials, see our article Endoprosthetics of joints.

    Intuition suggests that for an elderly person a superstroke is needed:

    • Material - ceramics( polyethylene and metal release harmful friction products)
    • Anatomical in shape - it fits to the entire surface of the femur, and does not come into contact with it at three points.
    • Adjustable length

    Unfortunately, it will be a very expensive prosthesis. ..

    With a fracture of the femoral neck and preserved integrity of the hip bone, a single-pole endoprosthetic replacement of

    is usually used. However, in the case of acetabular fracture, To do a total operation, which may require a modular cup with a patch that is inserted into the dips between the cup and the acetabulum.

    This cup is used in the destruction of the acetabulum

    Of course, this will further increase the price of the prosthesis and surgery.

    The exit for the elderly is only in a well-designed system of state quotas that carry out endoprosthetics for elderly patients not according to the cheapest option, but according to their history and health indications.

    If not endoprosthetics, then what?

    Often our broken old people do not even try to take to the hospital, leaving their homes to die, comforting tales of a false joint. They are motivated by the fact that:

    • is not possible for any endoscopy( mainly because of lack of money)
    • bones still will not grow
    • and rehabilitation for a weak person, they say, is impossible

    The video below suggests a treatment regimen if it is impossible to doendoprosthetics, in which the doctor advises in no case to abandon patients to abuse, do surgery( reposition with fixation of the neck of the head), and after the operation to carry out intensive therapy with calcium and protein preparations.

    Video: Fracture of the thigh in old age

    How to extend the life of the prosthesis

    The figure shows one of the optimal types of prosthesis with increased strength and a long period of wear:
    Friction unit - ceramic - polleyethylene
    Method of fastening the legs and cups - cementless

    What will be after -this issue is of concern to the patient who underwent complicated prosthetic repair of the TBS.

    It is believed that the life of the prosthesis is 10 years.

    However, in some cases it may fail much earlier:

    • An unsuccessful type not matching the anatomy of the patient
    • was selected. If the prosthesis was not accurately fitted
    • The operation was performed in the presence of contraindications
    • After the operation, contractures appeared that changed the natural angle of the hip
    • The cement method of fastening
    • was applied. The cheapest option( for example, metal + metal)
      Such a pair is undesirable, despite the high strength of the :
      • , due to the friction of the metal surfaces, the tiny metal particles
      • are formed, they,in the blood, cause allergic and even autoimmune reactions, muscle processes similar to

    tumors. To increase the life of the prosthesis, it is possible to use the pairs "ceramic-polyethylene" and "ceramics-ceramics"

    Theoretically, the term of wear of such pairs reaches 50 years, howeverThe joint wears out not from one friction, but from static and dynamic loads.

    Ceramics are considered absolutely harmless, while polyethylene liners and cups release harmful friction products - debris, which accumulates in the bones and causes inflammation in them, which subsequently leads to loosening of the prosthesis.

    Recently, to solve this problem, polyethylene parts began to impregnate with vitamin E.

    What is better - cement or cementless fastening?

    The stronger joint of the endoprosthesis is cement-free, because the porous external surface of the artificial joint literally grows the bone

    . But the cementless method, unfortunately, is not suitable for elderly patients with osteoporosis. :

    With a cementless connection,and pelvic bone: of course, with osteoporosis it can finish off the unfortunate bones of the elderly.

    Ways to improve the mounting

    The holes and denticles in the topped porous material serve for a better and more convenient attachment

    • Improves the fastening of the cups - the presence of holes in them and denticles:
      • The holes are necessary so that the surgeon can insert a hole through the holescavities and make an exact fit of the cup
      • Also holes can be used for additional fastenings
    • Coatings of cementless cups - pressed balls, trabecular metal, wire
    • Feet legsfor stimulation of bone ingrowth with cementless joints covered with hydroxyapatite, titanium sputtering or subjected to their abrasive sandblasting
    • Also on the legs are sometimes made arches, ribs and ledges that improve the fixation of

    Feet and cups in the cement joint are always polished, beautiful and shiny. This is necessary for a better contact between the glue and the surface of the prosthesis.

    However, as it turned out now, a beautiful leg does not always hold firmly.

    Ideal leg :

    This leg can last for a long time

    • Individually matched to the anatomical form of the femur canal
    • Has a porous coating( for a cementless joint)

    Such probably will last 100 years.

    But in the elderly, the cement fixing method is more often used. And the design of the endoprosthesis looks like this:

    Two variants of the TBS prosthesis for elderly patients

    There are two options:

    • Unipolar prosthetics - when replacing only the femoral part of the joint
    • Bipolar( total) prosthetics - with the replacement of the entire joint

    Revision endoprosthetics of the hip

    After endoprosthetics of the hipthe joint after some time may need a second operation.

    To bring to it may be such reasons:

    1. Wear of the endoprosthesis, which causes it to hold and hang loose( the head can dislocate and exit the acetabulum of the
    2. Fracture of the prosthesis part:
      Most often, the neck of the leg breaks.)
      Many of the legs are not integral, but with a detachable neck:
      • this design does notrequires the replacement of the entire leg with the audit operation
      • but on the other hand the assembly foot is less durable than the cast
    3. product. Breaking the bone:
      This is the most unfortunate pretext for a second operation, since it leads not only to the manufacture of newbut also to further sawing out the bone and reducing its safety factor. After all, in the near future, a bone graft

    may be needed Surgical surgery for hip replacement is more expensive than the primary surgery by more than 50%

    Rehabilitation after endoprosthetics of

    After endoprostheticship joint to rehabilitation begin with the first day .

    The terms of rehabilitation depend on:

    • Methods of fixing the prosthesis
    • Conditions of the patient and his age
    • The presence of pain and complications

    Read more about hip replacement after endoprosthetics - in the next article.

    In conclusion - a positive story in support of elderly people who have been severely injured - hip fracture and rehabilitation exercises.

    Do not despair! Desperate situations do not happen. At any age you can and need to overcome yourself.

    Video: How to take the first step from complete immobility to movement

    Lifetime general recommendations after hip replacement

    Endoprosthetics of the hip joint is called replacement of the damaged joint element. Special implants are used for this. Endoprostheses may be required for a variety of reasons( trauma and hip joint disease).After hip arthroplasty, certain recommendations should be followed.

    Replacement surgery for worn joint

    Reasons for prosthetics

    The most common reasons that endoprostheses may be required are:

    1. The started and severe stages of rheumatoid arthritis.
    2. Injuries of the neck of the thigh( most often fractures).
    3. Development of hip dysplasia.
    4. Presence of aseptic necrosis of the head, called avascular necrosis.
    5. Severe stages of coxarthrosis.

    The need for an endoprosthesis may arise due to post-traumatic effects( eg, arthrosis).

    The patient's life after endoprosthetics, as a rule, varies: a number of recommendations appear, which the patient must strictly observe. After endoprosthetics, there are some limitations, the patient needs special medical gymnastics.

    The patient has to walk on crutches for the first time. How long does it take to recover?

    The postoperative period and complete recovery depend on the patient's age, general condition and many other factors. In order to avoid complications after hip arthroplasty, all the recommendations of the attending physician should be observed.

    Exercises after a hip joint surgery should be performed strictly under the supervision of a qualified specialist. Life with the new regime will speed up the recovery process. Walking without the help of crutches the patient will be able to much faster.

    Pain after endoprosthetics, as a rule, have a pronounced character. Independently to take any measures in any case it is impossible, otherwise serious complications can be provoked.

    Features of the modern hip endoprosthesis

    To date, orthopedics has significantly succeeded in its development. A feature of the modern endoprosthesis is a complex technical design. In the prosthesis, which differs from cementless fixation, there are the following elements:

    • head;
    • leg;
    • cup;
    • liner.

    The difference in the endoprosthesis of cement fixation is a single acetabular element( cup and

    of what the joint prosthesis

    consists).Each individual element has its own dimensions. The surgeon must choose and set a size that is ideal for the patient.

    Types of fixation of hip joint endoprostheses have the following differences:

    1. Cement fixation.
    2. Cementless fixation.
    3. Hybrid type of prosthesis fixation.

    Reviews of each individual prosthesis are quite different, therefore it is recommended to collect as much information as possible before replacing the hip joint.

    The hip endoprosthesis can be:

    • total;
    • single pole.

    The use of this or that prosthesis depends on the number of replaceable elements. A knot of friction is the interaction in an artificial joint. How long can the endoprosthesis of the hip end? This will depend on the type and quality of the material used in the friction unit.

    When does a patient need hip replacement?

    The main indications for surgical treatment are the results of clinical and radiological studies and the symptoms that accompany the disease. Symptoms complained of by the patient are one of the most significant factors that indicate the need for an operation.

    In some cases, despite the fact that coxarthrosis is at one of the last stages of development( as evidenced by an X-ray study), the patient does not worry about anything. Necessity of surgical intervention may not be.

    How are operations of hip replacement performed?

    The operation to replace the hip joint is carried out by two teams( operating and anesthesia).The operating team operates under the supervision of a highly qualified operating surgeon.

    The place where the surgeon makes a cut for the joint replacement

    The average operation for the replacement with the hip joint is 1.5-2 hours, with the patient being under the influence of spinal anesthesia or anesthesia. In order to rule out infectious complications, an intravenous antibiotic is necessary.

    Rehabilitation after operation

    After endoprosthetics, the patient is still in the intensive care unit for some time, under the close supervision of doctors. Within 7 days the patient continues to be injected with antibiotics and drugs that can prevent blood clotting. In order to fix a certain distance between the legs, a pillow is installed. In this case, the legs should be in the allotted position. The temperature after the operation for the replacement of the hip joint is often unstable, so doctors carefully monitor this.

    How long will recovery take after hip replacement? This is impossible to predict. In order to speed up the process of rehabilitation, it is necessary to carefully follow all the recommendations of the doctor.

    Lifetime recommendations to be observed after endoprosthetics

    The patient is advised to move the next day. Without getting up from the pastel, the patient can sit down and even engage in therapeutic gymnastics. Exercises after hip arthroplasty, which the patient performs in the first month after the operation, are as simple as possible.

    In order to fully restore mobility, above the hip joint, it is necessary to constantly work, while observing all the recommendations of the attending physician. In addition to exercise therapy, the patient is assigned respiratory gymnastics.

    In most cases, the patient can walk on the third day of rehabilitation, using crutches and relying on the help of a specialist. How many days can I remove the stitches? It depends on how quickly the patient is on the mend. On the average, the stitches are removed after 10-15 days after the operation to replace the hip joint.

    How to live after discharge from hospital? Many people ask themselves: how to live after returning home? In the hospital, the patient is constantly monitored by the medical staff, who supervises the entire rehabilitation process. Life with the hip joint endoprosthesis is somewhat different from the usual life. As already mentioned, in order to restore mobility, the hip joint should be constantly working.

    The patient should walk as much as possible, not allowing a strong overwork. Exercise plays a big role in the rehabilitation process, all exercises must be approved by the attending physician. After discharge from the hospital, the patient can visit special centers where qualified instructors on exercise therapy will work with him.

    How long does it take to stay in a hospital? It depends on the general condition of the patient. On average, the initial recovery of the body takes 10-15 days.

    When returning home, the patient must understand that if he does not walk and work hard on the hip joint, the recovery process can be significantly delayed.

    Tips to follow after discharge from hospital

    To ensure that no serious complications arise after the operation, after the discharge, the patient should follow a number of recommendations:

    1. It is very important not to allow the full hip flexion.
    2. When the patient sits, the knees should not be flush with the hips. In order for the knees to be lower, it is recommended to sit on the pillow.
    3. Patient can not cross legs, in whatever position he is.
    4. When getting up from the chair, it is necessary to make sure that the back is straight.
    5. To walk on crutches is necessary as much as recommended by the attending physician.
    6. In the first days you should walk only under the supervision of a specialist.
    7. Shoes should be on a low sole, walking in it should be as comfortable as possible.
    8. When visiting a doctor, it is important to immediately inform him that the hip joint is artificial.
    9. After the operation, it is necessary not only to work on an artificial hip joint( walking, performing special exercises, etc.), but also to monitor the general condition of the body. In the event that in the area of ​​the thigh often there were painful sensations( which is accompanied by an increased temperature of the body), it is necessary to contact the attending physician.

    Probably, from many recommendations in due course it will be possible to refuse. Typically, this depends on how quickly the patient is on the mend. Often enough time for rehabilitation is 7-10 months.

    Additional information

    As you know, the endoprosthesis of the hip joint, like any mechanism, has its own useful life. Gradually, the prosthesis wears out, it is possible to walk with it up to 15 years. How quickly the prosthesis breaks down largely depends on what the conditions of its operation are. Active sports to a man with an artificial hip prosthesis are contraindicated.

    While doing physical therapy at home, the patient should understand that failure to follow the rules can lead to complications. Exercises should be fairly simple to perform. Do not overload the body.

    If during the exercise the patient feels pain and discomfort in the hip, it is necessary to abandon the exercise.

    Zero phase

    The time period of this phase is the first day after endoprosthetics. All movements are carried out very carefully. At this time, you can do the following exercises:

    1. "foot pump" - movement of the foot up and down several times( this exercise should be done throughout the rehabilitation period);
    2. short-term tension of the anterior hamstrings;
    3. shortening the buttocks and holding them in this position for five seconds;
    4. sidetracking and returning to the starting position of the operated leg;
    5. leg bending in the knee with heel support;
    6. rotation of the foot of the operated leg clockwise and anti-clockwise;
    7. lifting of the operated limb for a few seconds.

    All exercises should be done slowly and very carefully. Each should be repeated about 10 times. Not all of these exercises can be obtained immediately. If in the process of performing any movement there are difficulties, then it can be a little delayed, and a little later, try again.

    LFK after endoprosthetics - one of the elements of rehabilitation

    To prevent vascular disorders, it is recommended to bandage both legs with elastic bandages. Do not forget about a healthy leg: it is recommended to raise and lower the leg, and also to take it aside. It is forbidden to cross your legs. Lying is best on your back. If you need to lie on your side, there must be a roller between your hips.

    First phase( "strict care")

    The duration of this phase is from one to four days after the operation. The patient can already sit neatly on the bed. In this case, you can not cross your legs and strongly bend them in the hip joint, and also lie on the operated side.

    When sitting, do not allow the hip joint to be below the knee. Sitting is recommended on hard chairs, putting a pillow under your buttocks. It is not recommended to sit in soft armchairs, since when you stand up, the load on the hip joint will be too great. Lying on the bed it is recommended to take your foot to the side. Contraindicated to throw your foot on the leg.

    The next day after endoprosthetics, you can start walking slowly, leaning on crutches. Almost all patients are recommended immediately to try to step on the operated leg, the so-called load on the principle of tolerance to pain. By the fourth day, you can already walk 100-150 meters several times a day.

    New zero exercises are added to the exercises of the zero phase, which are performed in the standing position, but with support:

    • flexion of the legs in the hip and knee joints;
    • retraction of the straightened leg back.

    Phase II( "deceptive capabilities")

    This phase begins on the 5th and ends on the 21st day after endoprosthetics. During this period, an increase in motor loads is assumed. You can slowly descend and climb the stairs, for a longer time is paid to walking, observing the following rules:

    1. Walking is recommended not more than 30 minutes at a time.
    2. Going up the stairs, first put on the step of a healthy leg, and only then operated.
    3. Walking is allowed only with crutches or special walkers.

    The name "deceptive opportunities" this phase got because the pain is almost over, and the patient seems that he can already more than the doctor allows. Many of the patients neglect the rules, the observance of which prevents the dislocation of the joint, stop putting the roller between the hips. Violation of the rules can lead to increased pain and dislocation in the operated joint.

    The basic exercises of exercise therapy that are added in this phase:

    1. Lying on the abdomen:
    • flexing the leg in the knee so that the heel is directed to the buttocks;
    • lifting of the legs by the tension of the gluteal muscles.
    1. Lying on the back:
    2. alternating the legs to the sides;
    3. flexion of the legs in the knees, without detaching the feet from the floor.

    The third phase( "getting started")

    Exercises from the third phase of exercise therapy begin to do when the muscles and ligaments are strong enough, and the joint will get accustomed. As a rule, this happens 1-2 months after hip replacement. All exercises can be done at home. The load is increased by weighting. For this, elastic bandage is suitable. At this time, no longer need to put a cushion or pillow between the hips.

    The duration of walks on foot is gradually increased to 3-4 hours per day. Despite the fact that during this period, quite significant load on the joint is possible, it is recommended to stop exercising when pain occurs.

    Initially, the

    rehabilitator will help you with special exercises. Basic exercises:

    • flexion of the leg in the hip joint with resistance;
    • leads the operated leg to the side with resistance.

    In this phase, you can begin training on an exercise bike. The seat must be adjusted so that when the knee is straightened, the feet can barely reach the pedals. It is recommended to start lessons with the pedals turned back. The first classes should be short-term.

    Late postoperative period

    If more than three months have elapsed after hip replacement, and walking or pain in the operated leg results in pain or discomfort, you can unload it using a cane. Patients who underwent surgery for hip arthroplasty, after three months can return to work in production and drive a car. However, if the work requires active movements, it is recommended to take a break every one or two hours for rest. Those who do not imagine their lives without sports are recommended to ski, swimming and cycling. It is important to remember that self-medication after hip arthroplasty can not only do no good, but also cause harm. Therefore, before you begin to perform certain exercises, you need to consult with your doctor.

    Rehabilitation after hip arthroplasty: motor mode

    After completion of the operation to establish an endoprosthesis in the hip joint, a course of restoring the normal functioning of the joint and also the muscles adjacent to it is required. In this case, the duration and effectiveness of the rehabilitation course depends on many factors. Rehabilitation after hip arthroplasty is carried out according to different schemes. Therefore, it is necessary to apply an individual approach to each individual patient.

    Much depends on the age of the patient, on his general condition and physical development of the muscles. Accordingly, the older the patient, and also, the more he is physically weakened, the longer the rehabilitation process will take place.

    Also of great importance is how much time passed between the trauma and the operation. In the event that a rather long period has passed, most likely, the muscles managed to significantly atrophy, since the damaged joint could not function fully.

    A similar situation may occur with arthrosis. If the operation was carried out in a timely manner, when, despite the pain, the person could still move independently, and the muscles had to work, but to the critical point the matter has not yet reached, then the recovery process will be a little faster and more successful.

    But it also happens that a person suffers pain for years, hoping that everything will pass by himself. He turns to the doctor when the pain becomes quite unbearable, and a person can not walk.

    In such cases, the muscles have time to atrophy. Accordingly, the process of postoperative rehabilitation will take longer and more difficult. Considering all such factors, it is possible to draw up a general rehabilitation program that is applicable to all patients. This program is based on certain principles and goals, and an individual approach to each individual patient is also applied.

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    The rehabilitation process can be broken down into several periods or phases.

    Zero phase

    This phase of rehabilitation begins a few hours after the operation. First, it is necessary to restore blood circulation. This is required for the normal functioning of the limb and preventing the formation of blood clots in the blood vessels.

    Once the action of anesthesia has passed, it is necessary to do the following exercises( it must be remembered that all exercises should be performed by both legs, not just the patient):

    • Movement of the foot foot up and down, the so-called "foot pump".Exercise should be repeated several times every 10-15 minutes, as soon as the sensitivity of the foot returns. Do the exercise during the entire rehabilitation period.
    • Rotate the ankle to the right, then to the left 5 times. It should be remembered that rotation should be performed only at the expense of this joint. The knee does not participate in this exercise.
    • Work of the anterior muscle of the thigh( four-headed muscle).It is necessary to strain the front of the thigh, straightening. You can pull the socks forward. At first, there will be no full leg straightening, there may be pain. But it is necessary to try, and eventually the exercise begins to work out. Keep the muscles of the front of the thigh in tension takes 5-10 seconds. Repeat the exercise for 10 approaches for both( !) Legs.
    • Bend the knee, moving the heel towards the buttocks. The heel should be pressed against the surface. The knee should not rotate to the other leg. The hip joint should not bend more than 90 degrees. Repeat exercise 10 times.
    • Squeeze the buttocks and hold in tension for 5-7 seconds. Repeat the exercise should be at least 10 times.
    • In the lying position, move the elongated leg sideways to the maximum possible distance, then return it to its original position. In postoperative days, this exercise is likely to fail, but over time it begins to work out. Repeat exercise 10 times.
    • Raise the straightened leg up a few centimeters. As in the previous case, this exercise can not be performed first. Repeat the exercise 10 times.

    The first phase of

    The next phase of rehabilitation after endoprosthetics begins on the 2nd day after the operation. At this time, the patient will be able to get up and move gently on crutches, leaning against the injured leg, but not at full strength. Over time, this load will increase.

    The purpose of the 1st phase of rehabilitation is to restore the person's ability to move independently, including on the stairs( at first, of course, using crutches).

    When traveling, it is important to follow certain rules, namely:

    • To prevent dislocation, it is necessary to bend the leg in the hip joint by no more than 90 degrees. It is forbidden to cross your legs, squat and toss your foot on your leg, when such an opportunity will appear due to the subsidence of pain.
    • In order to avoid similar actions in a dream, it is necessary to put cushions between the legs.
    • You can sit down only on such chairs, where the knees will not rise above the level of the navel, that is, the hip joint will not bend over 90 degrees.
    • When lying on the back, the legs should be slightly apart, as in the sitting position.
    • Do not bend lower than the navel, when dressing shoes or other activities while sitting, lying or standing. Always remember about 90 degrees!

    Exercises of the 1st phase:

    1. In standing position, lift the elbow parallel to the ground. Hold the foot in this position for 5 seconds, then lower it. Several approaches are required for this exercise.
    2. In the standing position, straighten the leg and slowly take it back( you can hold your back in the lower back with your hand).Hold the limb in this position for 5 seconds, then lower it. Repeat the exercise several times.
    3. Standing elongated leg to the side. Hold the limb for 5 seconds, then lower it. Repeat the exercise several times.
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    The second phase of

    This phase of rehabilitation after hip arthroplasty begins about a week after the operation, includes exercises whose task is tomoving the patient on the stairs. They are carried out only with the supervision and assistance of a doctor, so here we will not touch on these exercises, since it is necessary to guide the attending physician, which is based on the patient's condition, as well as some other factors.

    Video: "Endoprosthetics of the hip joint: exercises"

    Third phase

    The third phase of rehabilitation begins 4-8 weeks after the operation, depending on the physical condition and age of the patient.

    In this phase it is necessary to master the movement without crutches, but still with the help of a cane.

    For the successful implementation of the third phase, the following exercises will help:

    • The elastic band is fastened in front around the ankle, and the other end - to a secure support. In the standing position, move the leg forward, then return it to its initial position. Repeat several times for each leg. This exercise should be done 10 times a day, in the morning, in the afternoon and in the evening.
    • The exercise described above is performed exactly the same way, only the elastic band is attached to the back of the ankle. In the standing position, take the leg back, then return it to its initial position. Repeat several times for each leg. This exercise should be done 10 times a day, in the morning, in the afternoon and in the evening.
    • Elastic band fastened to the side of the ankle. Take the straightened leg to the side, return the limb to its initial position. Repeat the exercise several times. Perform 10 sets per day.
    • The exercises on the exercise bike perfectly strengthen the muscles of the legs and develop the mobility of the joints. It is important to adjust the seat so that the legs are as straight as possible and hardly reach the pedals at the lowest point. First you should practice 10-15 minutes 2 times a day. Over time, the load should be increased and dealt with for 30 minutes 3-4 times a week, or more often.
    • It is important to conduct exercises for balance training. To do this, you must stand on one leg, leaning your hand against the wall, and rise up on your toe. Perform 10 repetitions per foot.
    • Walking on the treadmill in the opposite direction. The foot rolls from the fingers to the heel. When the entire foot is set on the treadmill, the knee is fully straightened. The speed of the track should be 1-2 km / h.

    Video: "Rehabilitation after hip arthroplasty: support and movement"

    So, after completing the entire rehabilitation course after hip arthroplasty, as a result of the exercises, a person should completely return the opportunity to walk normally without the help of a cane. In this case, the hip joint restores its functions. This usually occurs 7-8 weeks after the operation. It should be remembered that in order to prevent injuries in the future, you must constantly maintain your body in good physical shape, and after completing the rehabilitation course, you must perform all the above exercises.

    What is osteoarthrosis

    Osteoarthritis can affect any joints. Most often, DOA develops the knee joints, then the spine. Osteoarthritis of the hip joints is the third most common. The process can be either one-sided or two-sided.

    In this case, the cartilage is destroyed in the joint, lining the surfaces of contiguous bones, the articular fluid acquires a tendency to inflammatory processes, there are marginal bony proliferation. In later stages, the joint space( the gap between the bones) disappears, and movement in the joint becomes impossible. The causes of the disease are:

    • genetic predisposition;
    • injury;
    • metabolic disorders( eg, deposits in the joints of uric acid, hydroxyapatite).

    Characteristic symptom - pain in the area of ​​the projection of the joint, which increase during exercise( walking).The pain syndrome can reach such intensity, that the patient loses ability independently to move. Osteoarthritis can not be cured by conservative methods. With proper traditional treatment, only maintaining the state of remission is possible. So, the replacement of the hip joint is the only way to restore health and keep working capacity. The duration of the operation is 1-3 hours. It depends on what prosthesis is performed - full or partial. The patient is under general or spinal anesthesia. For rapid recovery and optimal treatment results, several hours after the end of the operation, special exercises should be started.

    Rehabilitation stages

    Initial phase( 1 day after surgery)

    First set of exercises necessary to improve blood circulation in the legs and prevent the formation of blood clots. Such a gymnastics is performed sitting or lying 3 times a day with both feet, regardless of whether the joint was replaced on one or both sides.

    1. Static tension of the quadriceps muscle of the thigh.
    2. Flexion of the leg in the knee.
    3. Move your foot up and down.
    4. Raising a straight leg 10 cm from the surface of the bed.
    5. Take the straight leg to the side.

    The first phase( 2-4 days after the operation)

    The patient continues to perform the already existing set of exercises. To them are added new ones.

    1. Raising a leg bent at the knee. The starting position is at the support.
    2. Straight leg to the side in standing position.
    3. Drawing a straight leg back in standing position.

    The main goal of this rehabilitation period is to go to full self-service( get up, sit down, walk, visit the toilet yourself).At this time there is a risk of dislocation of the prosthesis. In order to level it, it is necessary to sleep with a pillow between the knees, not to lie down on the operated side and not to keep the knees constantly bent, even if it reduces pain.

    Second phase( up to 21 days after endoprosthetics)

    Patient needs to continue to increase the load. At the end of the first week, you should learn how to walk neatly up the stairs. When climbing, you first need to step on the operated leg, then healthy, while descending - on the contrary.

    The risk of dislocation of the prosthesis is preserved, therefore it is necessary to follow all the recommendations of the previous stage.

    Third phase( up to 2 months after surgery)

    The phase of active training of the gluteal and femoral muscles. The elastic band acts as a kind of simulator, which allows all exercises to be carried out with resistance( flexion in the hip joint at the support, retraction of the leg in standing position).

    The patient should walk frequently and gradually, gradually increasing the time of walking up to 2 hours a day in several stages.

    In the department of physiotherapy exercises( in a hospital and polyclinic) the patient is assigned exercises on a stationary bicycle, which perfectly develop muscles, and also pacing on the platform.

    Fourth phase( up to 4 months after prosthetics)

    This time conceals a hidden danger to patients. Having successfully passed the previous stages of rehabilitation, having learned to walk without a cane, without feeling pain and limitations of mobility, people stop doing exercises. This is a big mistake! Insufficiently strong muscles, especially in the elderly, quickly detune, which increases the risk of injury( falling due to loss of balance, for example).

    Exercises to strengthen the leg muscles should be performed regularly for a long time, preferably for the rest of your life. It is impossible to be trained through pain. However, it is not necessary to confuse the pain in the joint with the pain in the muscles( due to the accumulation of lactic acid) and under this pretext to give up exercise. It is necessary to perform half-squats( strictly with a straight back), pacing, drawing a straight leg with resistance or a little burden, walking along a path or practicing on an exercise bike.

    You should also follow a balanced diet. The diet should contain a large number of proteins( except for the sick gout), carbohydrates( preferably long ones, ie cereals, whole-grain baking), fats( with sufficient amounts of omega-3 unsaturated fatty acids from seafood).Proper nutrition will not help gain weight to avoid stress on the joint.

    The list of medications will be issued by your doctor. It usually includes vitamin complexes and supplements containing glucosamine and chondroitin in therapeutic doses.

    Endoprosthetics of the hip with proper rehabilitation allows the patient to return to daily life in the shortest possible time.

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