Who needs hip replacement - rehabilitation after operation
The formation of the hip joint( TS), which is related to simple synovial joints, occurs with the participation of two jointed bones - iliac and femoral.
The bowl-shaped recess from the outside of the pelvic bone( acetabulum) and the ball-shaped bone of the femoral head together form a hip joint, which is a kind of hinge structure.
The head of the thigh is connected to the femur neck, which in the common people is called the "femoral neck" .The inside of the acetabulum and the head of the femur are covered with a layer of special articular cartilage( hyaline).
Cartilage is an elastic and, at the same time, strong and smooth interlayer in the joint. Provides slip during joint operation, releasing articular fluid, distributes load during movement and necessary cushioning.
Around the head of the joint is a capsule, consisting of a very dense and strong fiber-fibrous tissue.
Joint fixing occurs with using:
- Bundle. The outer ones are attached at one end to the femur, the others to the pelvic bone. And the inner ligament of the head of the hip bone connects the head itself with the acetabulum of the pelvic bone.
- Muscle. They surround the hip joint - the buttocks behind and the femur in front. The more developed the muscular frame of the joint, the less traumatic loads on it during running, unsuccessful jumps and movements of weights. Another important thing is that a good amount of strong working muscles delivers with blood sufficient amount of nutrients to the joint.
With the help of the hip joint, the person is simultaneously provided with such functional capabilities:
- body stability( support, balance);
- variety of movements.
We advise you to refresh your knowledge about how to treat gonarthrosis of the knee joint and what complications can cause this most serious illness.
Why the joint
is affected The obvious causes of injury include injuries. Examples are a fracture of the neck of the thigh, a dislocation of the TS or its subluxation.
To non-obvious - diseases( infectious and there are no arthritis, osteoarthrosis, inflammatory processes in the joint and periarticular tissues).In this case, over time, various complications develop which are expressed in injuries to the components of the pelvic joint - cartilaginous tissue, capsular, bone.
- pelvic inflammation - usually caused by arthritis of various etiologies, bursitis, synovitis, etc.;
- pathology of joint deflection - dysplasia;
- necrosis in the head of the TC of some parts of the bone marrow - non-infectious necrosis( avascular).
When and who needs hip replacement
The appearance of pain in the hip joint is a signal that one should turn to a professional to establish its causes. For this, an X-ray examination of the TC should be performed at the initial stage of the.
A solution to the problem for a worn or permanently injured joint may be endoprosthetics, which can be shown in such cases:
- is not a growing fracture of the TC head;
- fractures of the femoral neck or acetabulum in patients with advanced age;
- aseptic necrosis;
- is a tumor-like disease of the TS;
- deforming arthrosis of the third stage;
- congenital hip dislocation, etc.
What kinds of operations are offered by medicine
In the conditions of modern medicine, according to the type of prosthesis, patients are offered three types of operations:
- Replacement of TC surfaces - removal of cartilaginous interlayers from the acetabulum, with replacement of a special artificial material and turning of the head of the femur with a metal cap on it. Slip, due to this replacement of articular surfaces, is achieved close to the natural.
- Partial prosthetics - replacement, for example, of the pelvic joint head with a portion of the femoral neck, articular bed.
- Complete prosthesis - removal of the entire hip joint and its replacement by EP( endoprosthesis).
Types of endoprostheses
In modern day medicine there are more than six dozen modifications of endoprostheses. They are subdivided by the fixation method and the material. Methods of fixation today proposed three:
- cementless - fixation occurs due to the fact that the bone of the joint grows into the surface of the EP;
- cement - the endoprosthesis is fixed using a special bone cement;
- mixed( hybrid) - the cup is attached without bone cement, and the foot - with cement.
Modern combinations of materials, from which prostheses are made, are selected depending on the patient's illness, age and lifestyle. They can be as follows:
- metal - metal;
- metal - plastic of very high quality;
- ceramics - ceramics;
- ceramics - plastic.
Preparing for operation
All the necessary information for the preparation for the operation will be presented to you by the attending physician.
However, there are moments that the patient will have to prepare in advance( especially those who are lonely).
Since rehabilitation after joint replacement is continued at home, it is worthwhile to prepare your home for the post-operation period of recovery:
- purchase special equipment in the form of walkers or crutches, special toilet seat and so on;
- stop taking certain drugs( aspirin-containing, anti-inflammatory);
- if necessary, reduce your weight;
- to do physical training;
- visit the dentist;
- to abandon bad habits( smoking).
Before the operation of , the patient is obliged to issue the necessary documents to ( carrying out an operation for cash, under a contract under medical insurance or under quotas of the federal program for providing free high-tech medical care);talk with an anesthesiologist about the most favorable variant of anesthesia for you;at least 12 hours before the operation to stop eating.
Joint replacement operationModern advances in medicine make it possible to perform both open surgeries on endoprosthetics of the TC, and minimally invasive and minimally invasive.
Today, minimally invasive operations( MO) are most common because of their minimal impact on the body.
To carry out ,
- requires high qualification and professionalism of the surgeon and the entire medical staff;
- availability of technical capabilities( endoscopic equipment, high-tech materials).
Depending on the complexity of the operation( partial or complete prosthetics), its time can last from one to three to four hours:
- installation of a catheter into the urethra( to prevent involuntary urination and control the amount of fluid secreted by the body);
- incision from the outside of the thigh( or two small - on the thigh and in the groin area);
- peeling and shearing of tissues around the TC;
- prosthesis installation;
- restoration of tissue integrity and suturing of the wound.
The video clearly shows how the endoprosthetics of the hip joint passes.
Possible complications of
Any surgical intervention in the body can have its negative consequences. Complications after the procedure most often occur in operated:
- with a large deformation of the joint;
- with obesity or large muscle mass;
- have a number of serious concomitant diseases - diabetes, blood diseases, heart and all SSS, etc.
Joint replacement can cause such complications:
- is not the correct position of the endoprosthesis;
- damage to nerve fibers, arteries;
- disturbances in the process of postoperative wound healing;
- occurrence of infections;
- fracture of hip bone, dislocation or "popping" of the prosthesis;
- thrombotic events in veins of deep occurrence.
Rehabilitation after surgery
Rehabilitation after endoprosthetics can be long and take up to 6 months.
Patient should monitor at the seam, body temperature and sensation. Pain during this period can pass and return, the patient should be ready for this and make efforts to restore the motor functions of the body.
For the first few days of , the patient is prescribed analgesics, anti-inflammatory drugs.
Further rehabilitation after hip replacement consists in the appointment of special easy gymnastics and breathing exercises.
For the prevention of scarring of tendons and skin, to strengthen the muscular framework around the prosthesis is prescribed therapeutic exercise ( LFK) for the patient .
As the reviews of patients who underwent endoprosthetics indicate, it is necessary to adhere to the recommendations of specialists as much as possible and then rehabilitation will be quick and practically painless.Recommendations of specialists how to move and sit, what load to allow in the rehabilitation period( power loads - running, jumping - remove, engage in swimming) will allow patients to return to normal life in the shortest possible time.
How is rehabilitation after operation on the hip joint described in detail in the video.
Where it is possible to perform an operation in Russia
The operation of TC prosthetics is a high-tech process.
In 2015, the inclusion of high-tech medical assistance( VMP) in the compulsory medical insurance system is provided for by the new legislative draft "On Compulsory Medical Insurance in the Russian Federation".
Therefore, here we will not specify who will pay for the operation - patient or insurance companies.
The price of a hip replacement is made up of a prosthesis and the operation itself. To date, the cost of surgery( total hip arthroplasty) ranges from 210 to 300 thousand rubles ( depending on the cost of the prosthesis).
Replacement of hip joints in Russia is done both in federal budgetary health care institutions( FT of traumatology, orthopedics and endoprosthetics, regional clinical hospitals, research institutes) and in private clinics in Russia.
- OJSC "Medicine";
- Family Clinic;
- City Clinical Hospital No. 67( Moscow);
- KB Moscow State Medical University. Sechenova;
- Central Design Bureau of the Russian Academy of Sciences;
- Multipurpose medical center "K + 31";
- Central Design Bureau No. 2 of JSCo «Russian Railways», etc.
Endoprosthetics of the joints. How to cut costs and how to start treatment in Moscow?
Is it possible to make a joint replacement in Moscow as efficiently as possible and at the lowest cost. Investigation of the project "Doctors of the Big City"
Endoprosthetics of joints in Moscow until recently was carried out due to quotas for high-tech operation, which the state allocated. To be more precise - hip joint endoscopy was carried out at the expense of quotas until 2014.Since 2014, quotas for most such operations have been canceled , with the exception of some systemic diseases, for example - systemic lupus erythematosus or for iatrogenic reasons( doctors' mistake in the initial replacement).
In most cases, there is simply no quota for the replacement of the hip joint. The same picture is with the endoprosthesis of the knee joint, but since 2015. Operations to replace joints are expensive and most citizens can not afford to pay both the cost of the endoprosthesis, and the cost of the operation itself. It was planned that operations on arthroplasty will be carried out at the expense of the MHI policy, but so far this period is transient and, often, misunderstanding and confusion on the part of hospitals and doctors arise.
Endoprosthetics of joints
Let's consider some variants of replacement of joints. Just note that there is a way out and you can significantly reduce the costs , and in most cases generally avoid financial losses. But let's start in order.
Completely commercial operation to replace joints in Moscow clinics
This is the fastest way to replace the joint. Here, too, has its own nuances.
1. Operation in a private clinic
In the first case you can go to a commercial clinic, conduct an arthroplasty in Moscow and pay for the joint, and for the operation, as well as for bed-days, medications, anesthesia, etc. Prices in Moscow vary from 300 000 to 700 000 rubles for large joint ( knee or hip).
2. Operation in the state clinic
The second option is the Moscow State Clinic or a large federal center. In this case, you pay only cost of the joint .The operation and being in the clinic is carried out free of charge , under the policy of CHI.It should be done! Be careful. Some hospitals ask for more payment and the operation itself. To put it mildly, this is not entirely correct. This option is ideal when there is no time to collect medical and administrative documents.
Replacement of joints by quota
As quotas have not been finally canceled, we will consider this option in more detail. This way has its pluses and minuses. The main positive point is that everything is done initially for free .And the algorithm of actions is quite simple and looks like this:
Initially, you go to the clinic, provide pictures and medical documents. If the clinic has quotas for the replacement of joints, after consultation you will be given a so-called "Protocol of quota solution" on hand. With this official document, passport and MHI policy, you are going to the MH of the city, where within 10 working days your ticket for the VMP( High-tech Medical Aid) and your data will be included in the general plan of operations for the near future. Then you just have to wait.
Waiting time can vary greatly depending on the clinic. On average, this is 3-8 months. In large centers, you can wait more than a year. This is just the first minus. Further. The time of the operation has come and there are still a number of questions:
- What endoprostheses are put on a quota?
- Who will operate: an experienced orthopedist or a young surgeon?
By the quota put those endoprostheses, which are currently in the clinic. It's far from a fact that these will be endoprostheses of leading companies. But no matter what endoprosthesis is put, the success of the operation depends largely on the experience of the orthopedic surgeon. Incorrect installation will not help even with endoprosthetics "the best prosthesis".Agree, this is also a minus of this path when replacing the joint.
It is asked: is there any alternative for replacing joints? We dare to assure you, there is such an alternative. So the third way.
Individual Rehabilitation Program( ASI)
Surprisingly, with the help of IPR it is possible to supply a good, high-quality prosthesis. To put this endoprosthesis in one of the leading Moscow clinics, in excellent conditions and in the shortest possible time. And all this at the expense of budget funds .
How does this happen? As they say - all ingenious is simple.
Consultation with the doctor, then the preparation of the initial documents for the IPR and hospitalization in the clinic. Next, the operation and, at the time of discharge from the hospital, processing documents for the return of funds .The only drawback of this scheme is that initially before hospitalization, you are buying this joint by cashless settlement from one of the companies of the manufacturers. But then you get this money back!
The average time from primary treatment to operation is approximately 3-4 weeks. Money is returned, usually within three weeks after discharge from the hospital.
Endoprosthetics of joints. Price of
On average, good and quality endoprostheses cost from 100 000 to 150 000 rubles. The amount of compensation varies depending on the region. In Moscow, is returned to 168,800 rubles inclusive. Moscow region and regions: about 110 000 rubles.
Thus, the Individual Rehabilitation Program( IPR) allows almost any patient to replace the joint with a modern endoprosthesis. Do it in a short time and absolutely free.
Details can be found by calling or sending an application for treatment.
Hip replacement: surgery, choice of prosthesis
By endoprosthetics means the replacement of a damaged or worn joint by an artificial implant, which allows to restore lost mobility. As a result, patients return to normal life within a few months after the operation. The replacement of the hip joint is the most effective method of treating the articular pathology, when the therapeutic agents are ineffective.
Indications for endoprosthetics
Prosthesis of the hip joint is in many cases the only highly effective means of restoring the mobility of the joint damaged due to:
- degenerative-dystrophic diseases affecting the ligament-articular apparatus, for example, osteoarthrosis or arthritis of various etiologies;
- autoimmune processes, within which the body begins production of antibodies to cartilaginous tissue;
- inflammatory processes, leading to decreased mobility of the joint;
- aseptic necrosis;
- congenital anomalies and the consequences of injuries sustained.
Artificial joint will get rid of the painful manifestations of these ailments. In the final stages of degradation, due to certain features of the anatomy of the joint, the pain becomes chronic, causing the patient to abandon his usual occupations. Painful manifestations have a significant impact on the psychoemotional balance.
Surgery for endoprosthetics
Endoprosthetics of the hip refers to high-tech procedures that require careful preoperative examination of the patient. Surgery to replace the joint is a surgical intervention that increases the risk of internal infection and thrombosis. In the framework of careful analysis and the collection of detailed history, factors that increase the risk of postoperative complications are established. Preoperative examination also plays an important role in ensuring safe anesthesia.
During the examination of the hip joint, the specialist determines the condition of the affected area and selects the prosthesis most suitable for the specific case. The choice of the type of construction and the cost of the materials used determines the final price of the hip joint prosthesis. In general, the cost of hip replacement is determined not only by the type of implant, but also by the unique characteristics of the patient that determine the preoperative measures and the course of rehabilitation.
The cost of surgery and supplies
The cost of treatment includes all necessary services( stay in the ward, surgery, anesthesia, physiotherapy, medicine, nutrition, etc.), except for implants( prostheses, screws, plates, etc.).
Rehabilitation after endoprosthesis
Within the framework of the postoperative period, the foundation is laid for ensuring the normal mobility of the artificial hip joint. In the first few days gymnastics for rehabilitation includes isometric exercises for stress of the femoral muscles, as well as respiratory gymnastics, interfering with the development of pulmonary and cardiovascular pathologies.
A hip joint prosthesis will allow you to return to normal life, but you will first need to learn how to get up and sit down, climb the stairs, etc. As rehabilitation, the complex of treatment procedures is significantly expanded, with the aim of increasing muscle strength and adapting the patient for routine operations.
In most cases, the patient can leave the clinic after two weeks, when the main stage of postoperative rehabilitation is completed. Unfortunately, in a number of cases during the recovery period the pain returns, as a result of which the patient instinctively "pities" the joint, delaying the period of complete recovery. In addition, discomfort and painful manifestations in the hip area are the cause of unsupported reasoning about the unsuccessful operation to replace the joint.
Therefore, the replacement of the hip joint in Moscow is subject to the control of the patient's psychoemotional state and correction of the complex of therapeutic exercises. To restore the lost functions, depending on the degree of damage to the joint, it takes from a month to six months. After that, the patient can return to the usual life with a full load on the endoprosthesis.
To install an endoprosthesis replacing a hip joint, it is necessary after traumas, fractures and in the presence of other severe pathologies.
It should be noted that endoprosthetics, for example, in Germany is carried out according to the following indications:
- Congenital dislocation of the femoral neck.
- Osteoarthritis and severe osteoarthritis.
- Disease of Perthes, Bechterew.
- Tumor processes in the hip joint.
When considering the operation of endoprosthetics, other factors are taken into account, such as the general condition of the person, concomitant pathologies, the degree of damage to the operated area and the entire hip joint.
In addition, like any manipulation, this operation also has contraindications. The endoprosthesis should not be placed if there is:
- Presence of an infection in the body.
- Cardiovascular diseases. Severe renal and hepatic insufficiency.
Before the endoprosthesis replacement for hip replacement in Germany, Israel or another country, examinations( laboratory-instrumental), the patient are consulted by specialists. Possible correction of the state of drugs and physiotherapy before surgery and joint replacement.
Endoprosthetics Endoprosthetics and replacement of a damaged hip joint can be performed in two ways:
- Single pole replacement - replacing only the hip component, instead of it a prosthetic foot is installed. With this type of endoprosthesis, the acetabulum remains untouched.
- Full joint replacement when all parts of the hip joint completely replace the endoprosthesis.
Stages of operation
As with any surgery, some complications are possible after endoprosthetics
At the first stage of preparation for endoprosthetics, consultation with the attending physician and surgeon is necessary. This is necessary to determine contraindications, if any. You should also take an X-ray, which will show how affected and worn the hip joint is.
The next step is to take all the tests and diagnose. Hospitalization is carried out a couple of days before the operation.
The procedure is as follows: a prosthetic leg is inserted into the center of the femur, it will be inserted in place of the neck of the hip, then a head with a liner is inserted, thanks to which the leg can move. After repositioning the head, the surgeon checks the length of the limb, selects the endoprosthesis of the required length and dimensions and installs it. The prosthesis is fixed using a special bone cement, which grows to the bone. As a result, the incision, where the prosthesis was, is washed with a special antiseptic substance and all the tissues are sutured along layers. On the upper layer of the skin are installed special staples. Perhaps the person will be interested in the very process of such a procedure. On the Internet you can see the video and photo operations. How long the procedure lasts depends on the specialists, in general, it takes about an hour.
The procedure for the replacement of the hip joint in Israel, Germany, Russia takes into account the anatomical structure of the operated area. Intervention requires general or epidural anesthesia. The incision is small, and the implants themselves are made of durable material. After the operation, for example in Germany, the patient is in the clinic for another week, he is observed by specialists, since the new artificial hip joint should take root.
As with any intervention, endoprosthetics may have complications. These include:
- Dislocation of the femoral neck - such complications occur when the globular head of the prosthesis moves away from the acetabulum.
- Infectious complications.
- Damage to the blood vessels and nerves of nearby tissues.
- Complications associated with intubation in anesthesia( eg, pneumonia).
To avoid the development of complications, it is important to stop smoking and not taking alcohol, to fight excess weight, if such a problem exists, to treat all foci of infection in the body.
intervention After a surgical intervention, a rehabilitation period begins. The patient is discharged in Russia a few days after the intervention, in Germany, strictly after a week. This is an inadequate period for the restoration of the new joint to be complete. The duration of the process depends on many factors, one of which is the presence of possible complications.
The rehabilitation period after the operation can be quite long
Dependence on the previous pathology is traced:
- If there was a neck fracture, then the time through which the prosthesis was inserted is important. When the time passed not so much, the muscles are included in the work quickly enough.
- If the prosthetics were several years later, the atrophied muscular frame needs more time to fully fulfill its function.
- If a person has suffered pain for years, the cartilage and bone wear out, the muscles atrophy, and the replacement is done "at the last minute," then rehabilitation can take a long enough period.
An extract after joint replacement is carried out in a week. In Russian medical institutions, patients can be discharged in a few days. But this does not mean that the body has recovered. How much time will take the recovery period, directly depends on many factors, including the possibility of complications.
It is important to take into account the pathology due to which the joint was made:
- If the bones and cartilage are worn out, the muscles are atrophied, after the prosthesis has been performed, the rehabilitation period can take a long time.
- Prosthesis after fracture depends on how quickly the operation was performed. The sooner, the sooner the muscles adapt.
- If prosthetics were performed a few years after the injury, it will take a long time to completely adapt the muscle framework to the prosthesis.
Either way, the body of each patient is individual, and it also matters in the duration of the recovery period.
Fortunately, to perform prosthetics, you do not need to go to Germany or anywhere else. In Russia, such a procedure is conducted in Moscow on a quota paid by the state. It is worth noting that the replacement of the joint is very expensive. For example, in Germany the price of a hip replacement is from 10,000 dollars. In addition, you will need to pay for a place in the ward, tests and so on. As a result, the cost will be about 20,000 dollars. Rehabilitation after the replacement of TBS is also expensive.
To operate on a quota is not an easy task. First, you need to issue the quota itself, and then you need to apply to the hospital with a coupon for high-tech assistance( VMP ticket).Your data is placed in the queue for an operation of endoprosthetics for the current year. The expectation in Moscow takes an average of about six months, it should be taken into account in its plans.
How much will the prosthetics cost, depends primarily on the material from which the prosthesis is made, the clinics where the operation is performed. The price of the operation depends on the doctor's qualifications, patient care, placement in the ward and patient care, depending on how much he will be in the institution. Before the operation, doctors discuss all these nuances, and also show the patient on the photo how the new limb looks from the inside. The photo will help the patient to accurately understand what kind of appearance will be at the joint from the inside.
Table 1. Prices for the operation for the replacement of the hip joint
Operation to replace the knee joint: gymnastics and LUTS after hip replacement, rehabilitation, reviews |Are joints aching?
The operation to replace the knee joint is one of the most popular in the field of orthopedics. It is the latest treatment for the treatment of diseases in the final stages, which are the destruction of the knee joint. The operation is preceded by a survey. Based on the results, which is the decision to partial or complete replacement of the joint.
Indications for operation
The operation of knee arthroplasty is indicated for such diseases as deforming arthrosis in the last stage, deforming coxarthrosis, purulent melting of the joint, some types of trauma, systemic diseases( Bechterew's disease, rheumatoid polyarthritis).In the unfavorable course of these diseases, the patient experiences severe pain and discomfort, the volume of movement of the joint becomes insignificant.
The patient loses the ability to move normally. Conservative treatment, by the time the decision to conduct the operation was taken, has completely exhausted itself, and doctors do not see any other way to help. However, there are a number of exceptions, when, despite the seriousness of the situation, physicians are forced to refuse surgical treatment.
Replacement of the knee joint contraindications
- Serious disorders in the cardiovascular system.
- The formation of chronic foci of infection.
- Infectious process, passing in the knee itself.
- Disorders from the psyche.(In this case, the patient will not be able to fully fulfill all the requirements of the doctor in the postoperative period.)
- The operation will not be performed if there are serious vascular and blood diseases, oncology, severe obesity.
Endoprosthetics of the knee joint, the operation is always planned. At her moment, the patient should undergo a comprehensive examination and has on his hands pictures confirming irreversible changes in the knee joint. Again, all possible options for conservative treatment are considered. And only after that a final decision on the behavior of the operative intervention is made.
The patient is offered to perform an autologous blood donation. This procedure consists in transfusion during the operation of the blood of the patient himself, collected in advance in the preparatory period. In this case, the risk of complications is significantly reduced.
How is knee replacement surgery performed?
The operation lasts about two hours. The process of replacing the joint with an artificial prosthesis is under compulsory anesthesia. With complete anesthesia drugs are administered intravenously through the respiratory tract. The patient is in a state of sleep until the very end of the operation. Possible surgery with the introduction of drugs in the lower spine. The method of anesthesia is chosen based on the characteristics of the patient's condition. At the same time, the patient is given an antibiotic to reduce the risk of an inflammatory process. The operation begins with a cut in the joint area to access its internal surfaces.
At the next step, parts of the cartilage are removed from the tibia and femur. After this, the implant is fixed. Implants come in two forms: metal and plastic. The wound must necessarily be filled with drainage, which must ensure the outflow of the accumulating liquid - blood and exudate. After that, the seams are applied. In an operation, blood loss is usually minor, but there are exceptions to the rules, then doctors perform blood replacement therapy.