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 endoprosthetics of the hip joint can be carried out 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 physiotherapy procedures, including 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.
AFC after hip arthroplasty
After a hip replacement, a long rehabilitation period is required. For complete recovery should be developed as an operated limb, and healthy. That the muscles and ligaments do not atrophy and do not lose their functionality, it is necessary to start a specially developed complex of exercise exercises( both legs) a day after the surgical intervention.
Early stage of rehabilitation of
At 1-12 days after endoprosthetics, it is recommended that such exercises performed in the supine position on the back are recommended for the operated leg( the first 3 days are forbidden):
- ankle joint development - flexion and extension of the foot;
- Extension of the limb in the knee with keeping it in the position of statistical stress( 5 sec);
- gluteus muscle tension and retention( 5 sec);
- Extension of the limb using a platen under the bend of the knee;
- pulling a straight leg to the side without lifting it from the surface of the bed;
- lifting a straight leg up, without lifting the pelvis.
The described exercises should be repeated from 5 times each, and the complex itself is performed at least 2 times a day.
LFK after endoprosthetics of the hip joint is also prescribed for a healthy limb. The main task is to develop all the connections: the ankle, knee, hip( flexion, extension, rotation, tension, lifts and leads).
Prohibited movements :
- flexion in the hip joint at an angle greater than 90 ° C;
- low slopes;
- turns the thigh in and out.
You can start walking from the 4th day using crutches or walkers as a support.
Late stage of rehabilitation
For 2-12 weeks of the recovery period, the walking time reaches 30 minutes( 3 or 4 times a day), the distance and pace gradually increase. A pole is already used for the support.
At this stage, exercises of exercise therapy after endoprosthetics of the hip joint are complicated. The increased loads for the operated limb.
In the supine position on a flat surface:
- flexion of the leg in the knee( without detachment of the foot from the surface of the bed);
- sideways to the side;
- bending in the knee, straightening and lifting up, returning to the starting position.
In the position lying on the abdomen:
- flexion of the limb in the knee before touching the foot with the buttocks;
- bending both legs in the knees and tearing off the floor with the help of the gluteus muscle tension;
- lifting straight legs also by straining the buttocks.
These exercises should be repeated up to 15 times, the whole complex - 2 times a day. Parallel to develop a healthy leg on the same principle.
The final stage of rehabilitation
At the 13-17th week of rehabilitation, it is already allowed to move without support, but if prolonged walking is accompanied by pain or discomfort, then a cane should be used.
The exercise of exercise therapy after hip arthroplasty at this stage is similar to that performed in the previous stage. The difference is only in increasing the load on the lower extremities( wearing weighting agents).Supplementary activities are half-squats with and without support. But, still bend the thigh more than 90 ° C is strictly prohibited. You can not also cross your legs and sharply unfold in the joints.
To achieve early recovery of the hip joint and return of its mobility, it is recommended to supplement exercise therapy with swimming, cycling or skiing.
Rehabilitation after hip arthroplasty: make your new joint work
Hip replacement is an operation that solves the problem of reduced leg mobility and soreness. 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 suffer 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 period of recovery 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.
To avoid 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 be seen by the doctor, then you will quickly find out 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 still can not be bent 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.
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 of the hip joint
These operations have been carried out for thirty years and every year it is carried out using 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 pelvic and femoral joint elements) is, first of all, a more long-term operation of the implant, which eliminates the need for revision of the hip joint revision. 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.
Reconstruction 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 excessively sharp movements, turns with legs, crosses, and so on - all these manipulations will negatively affect the patient's well-being and the speed of his rehabilitation.
- Lying on the side( only 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 another month at home. To increase the chances of completely rehabilitating, the patient must strictly follow the recommendations of doctors.
It is more difficult to be rehabilitated to the elderly, so medical rehabilitation begins 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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