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 the 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.
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 spikes
- Coagulation 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 a current of blood 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 therapyThere 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 - 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, exercise therapy is necessarily combined 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.
Complex of exercises after hip replacement: exercise bike, video |Are joints aching?
Knee joint endoprosthetics is an operation to replace a damaged joint with an analog, but, alas, is artificial. This procedure is considered successful when the operation has gone without unnecessary problems and complications, and the patient is provided with proper joint care during the rehabilitation period.
The rehabilitation period, which is performed after arthroplasty, has 3 main goals:
- to learn how to get up on your own;
- learn to safely stand and sit;
- learn how to walk normally.
Basic rules how to get up correctly:
- must necessarily stand in the direction of a healthy leg;
- before getting up, the operated leg should be pulled forward and hidden;
- make sure that the flooring is not slippery;
- rely only on crutches and an unoperated leg.
The first days of rehabilitation
After the operation, doctors recommend a set of exercises after hip replacement, which, if carried out continuously, will quickly put the patient on their feet. The next day after the operation is already recommended to get up. But the body is still experiencing weakness, so you need the support of a relative or acquaintance. Even in spite of the slight dizziness that the patient may experience, one should still try to get up. The sooner this happens, the faster it will be possible to walk.
The course of rehabilitation should necessarily include physical exercises after hip arthroplasty. But to achieve a good effect, you need to perform exercises about 2-3 times a week.
Here are the basic exercises:
- Extension and flexion of the ankle joint. Begin with five repetitions, and gradually increase the amount.
- The following exercise focuses on the tension of the front thigh muscles. It is recommended to keep these muscles in tone from about 2 to 5 seconds. The same exercise should be performed for the hind femora.
- Exercise that involves lifting a straightened leg. It is necessary to raise the foot by 45 degrees and so hold for about 3-5 seconds. Be sure to bend and unbend the knee.
- A very useful exercise is to remove the straight raised leg in the side( hold for 5 seconds).
The level of physical activity throughout the course of rehabilitation should gradually increase. You can, as an alternative, use walking, massage, swimming bicycling( but only for a short time).
Exercise bike after hip arthroplasty
After more than a month has passed since the day of surgery, doctors strongly recommend that you exercise on an exercise bike.It is an exercise bike - an excellent and indispensable assistant in strengthening the muscles, as well as "working out" joints.
In the first place, an exercise bike should be properly adjusted for yourself. The seat of the exercise bike should be at a certain height: the leg with the straightened knee hardly needs to touch the pedal of the simulator. At the first stage of the pedal, it is recommended to turn in the opposite direction. And only with the transition to the second stage, you have to turn the pedals forward only when they turn back easily. With the strengthening of the muscles, the load also needs to be increased. At the beginning of work on the simulator, the pedals should be turned forward no more than twice a day( about 10-15 minutes).Over time, it is advisable to go for 20-30 minutes. Also it is necessary to remember the right of the "right angle", which prohibits categorically raising the knee even slightly above the hip joint.
In the first two days after the operation for the replacement of the hip joint with a prosthesis, procedures for UHF or magnetotherapy with exposure to radiation and temperature to 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 to mobilize the CNS and strengthen the complex of metabolic-trophic processes in the muscles. This gymnastics is especially indicated for bilateral hip joint lesions.
Four days after the operation to replace the hip joint with a prosthesis, one must start learning to walk the stairs in the houses, always leaning on the handrail 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;
- to rearrange the operated leg on a step above;
- put on the 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 foot;
- attach 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.
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 is shown:
- exercises for small joints of the limbs;
- exercises for diaphragmatic and thoracic breathing;
- sitting in bed with the hands.
Special attention should be paid to the placement and fixation of special surgical limbs after endoprosthetics. The rollers are placed under the knee joint and from the outside to exclude the external rotation of the thigh.
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:
- 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.
- Flexion in the hip joint( 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.
- 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 confident 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 simulator exercises are recommended( consult a 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 lies 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 - aqua aerobics, salt and coniferous baths of a certain temperature, shower-sharko, etc. can be used.
Replacement of a weaker load with a heavier load is allowed no earlier than 2-3 months, if the rules are not observed, complications can arise. 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.
Hip Endoprosthetics: Recovery and Rehabilitation
The hip joint is the largest joint in the human body. Connecting the torso and legs, it gets a lot of work, so the diseases and lesions of this joint cause unbearable pain, which requires immediate medical intervention.
Among hip joint diseases: coxarthrosis, infectious arthritis, pathology of blood supply to the bones, and others. Endoprosthetics of the hip joint is the replacement of the destroyed joint element on the implant. The implant can be made of materials such as metal or ceramics and contain stainless steel, cobalt, chromium or titanium. The surgeon selects the appropriate material and size of this material, based on individual indicators. The prosthesis( older people) serves a lifetime, but younger patients may need a re-operation for the hip joint.
Operation for hip joint
These operations have been carried out for thirty years and every year it is carried out with the help of more and more advanced technologies that significantly improve the results. As a result, patients suffer unbearable pain that accompanies any hip joint damage. In order to avoid complications during and after surgery, tell your doctor full information about your health condition. If you smoke, the doctor must know about it, since nicotine affects both the speed of rehabilitation and the patient's well-being during the operation. That there were no unforeseen circumstances, also it is not necessary to place the stomatologist before operation - the blood from a mouth can get in a blood flow, having infected a joint. Endoprosthetics of the hip requires a thorough examination.
During the operation, sometimes the blood of a patient suddenly suddenly becomes necessary - better give yours in advance, because it is not known how the body reacts to someone else's blood, which is usually prepared by doctors for every firefighter.
Total hip arthroplasty( replacing both the pelvic and femoral joint elements) is primarily a longer-term implant operation, which eliminates the need for revision hip replacement. In addition, in this case, the implant performs its function better, although there are disadvantages: this operation is more dangerous and blood loss in this case is greater.
Complications of hip arthroplasty are and depend on the characteristics of the body and the lifestyle of the patient, and also on the quality of the operation and the knowledge of the surgeon conducting it. Statistics show that the most common complications arose with the use of low quality implants - these are the first implants of the last century. With the progress in modern medicine, the number of complications has significantly decreased. After carrying out endoprosthetics of the hip joint, the patient can apply for a pension. The disability group after hip arthroplasty and the size of the pension, respectively, is determined by the indicators of the patient's ability to move, go to the store and so on.
Recovery after hip joint surgery
The duration of recovery after surgery depends on the patient - each rehabilitation period is individual. Recovery after hip arthroplasty does not include any specific technique, but some rules should still be followed.
- Sitting on a chair, put a pillow on the seat so that your knees are below your hips.
- Avoid too abrupt movements, turns with your legs, crosses and so on - all these manipulations will negatively affect the patient's well-being and speed of his rehabilitation.
- Lying on your side( not on the leg that was operated on), lay a small pillow between your legs to avoid displacement.
If symptoms such as fever appear, pain increases, swelling or other similar phenomena occur, then immediately consult a doctor.
It is worth remembering that it is important when exactly the operation was performed - immediately after the joint failure or after a long time. Of course, in the first case, the work of muscles can recover completely, which can not be said about the second case.
Rehabilitation after hip arthroplasty begins already in the hospital and continues for about a month at home. To increase the chances of completely rehabilitating, the patient must strictly follow the recommendations of doctors.
It is more difficult to rehabilitate old patients, so medical rehabilitation is begun before the operation. Of course, endoprosthetics of the hip joint, whose rehabilitation takes time, is a complicated procedure, but do not despair - you will succeed.
Exercises for rehabilitation after hip arthroplasty
Exercises are an important part of restoring the muscles that will atrophy if they are not done. Exercises after hip arthroplasty are quite painful, since pain immediately after the operation does not subside. However, do not spare yourself too much, because then it will be much more difficult to recover.
It is important that the patient knows what he is facing. Endoprosthetics of the hip joint, the video of which can be viewed on the Internet, will give you an idea of this.
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