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 according to 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 endoprosthetics of the hip joint as long as possible do not need a second operation
- What is the revision prosthesis
In somejoint replacement surgery is vital
Hip replacement: pros and cons
Hip joint structure
- TazobedrumThe joint connects the femoral and pelvic bones and has a hinge structure:
- The pelvic bone has an acetabulum, in which the gluteal head of the ball-shaped
- holds and rotates with the ligaments and muscles. The head is connected to the thigh itself with the neck at an angle of 125 - 145 углом
- The surfaces of the head and cavities are covered with a cartilaginous layer, both strong and elastic
- The joint is closed by a capsule filled with synovial fluid
- Uniform lubrication of the joint provides the acetabular lip -on the edges of the acetabulum
Such a perfect structure provides greater mobility of the joint, the ability to perform extensor and rotational movements of a wide amplitude.
Video: Anatomy of TBS
What can cause joint replacement
A number of diseases lead to the development of the hip joint resource:
Deformation and fractures in the joint often cause pain and limb movement in the
Deforming osteoarthritis, during which the :
- cartilage graduallyerased and destroyed
- volume of articular fluid decreases
- the distance between the surface of the head and the acetabulum is shortened
- movements in the joint are limited to
VospaLenie TBS because of osteoarthritis plus systemic arthritis :
- Rheumatoid and psoriatic arthritis
- Ankylosing spondylitis
- lupus erythematosus
Congenital dysplasia :
- Dislocation TBS
- Underdevelopment acetabulum
Aseptic necrosis of head :
arises due to circulatory disorders, such as, with the squeezing or rupture of blood vessels feeding the head of the thigh. Usually this occurs with
injury. fracture of femur neck:
Often complication of osteoporosis to old age, resulting in painful pain, complete disability and premature death
When TDS endoprosthetics are needed
Replacing TBS with arthrosis and arthritis
There is no need to replace the joint with 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
With congenital dysplasia, the attitude towards 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 the fracture of the femoral neck in old age, endoprosthetics become the only salvage, 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 femoral neck becomes impossible due to damaged vessels and developing osteonecrosis
- Even vertical fracture line is unsuitable for splicing
Even if the vessels are not damaged and the fault line is horizontal,for osteoporosis will be extremely slow and it will be difficult to restore the joint.
How the operation is performed
The essence of the operation in the articulation of the articular bones, the successive selection of the leg and the cup and their subsequent attachment
- The template is produced by the fillet of the neck and the femur head
- The femur canal
- is drilled.increasing the size of the rasp until the latter rests tight
- On the rasp, put the head on and check how the joint moves
- After selecting the stem and the head, the canal is drowned in the boneCoy and a syringe filled with its adhesive
- Putting the end of the centralizer legs administered it in another liquid adhesive
- After five to eight minutes, removed excess cement
fastening produce all the same operations, only matched leg spikes into the channel until the complete jamming.
Hip replacement in both cases is performed under regional spinal anesthesia .
Video: Surgery to replace TBS
What diseases can not replace
- Diabetes of primary and secondary type
- Incontinence or poor blood coagulation
- Hypertensive crisis
- Recently experienced heart attack or stroke
- Acute blood leukemia
- Exacerbation of systemic arthritis,bone tuberculosis, osteomyelitis
- Exacerbation of chronic diseases
- Bone metastases in 4 stages of cancer
About preparation for surgery and necessarythe first steps to recovery, read the article Endoprosthesis of the knee joint
When contraindication is laziness
If you suffer from pain in the TBS and limit your freedom of movement, but you are lazy, afraid of physical exercises, 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 operation, 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 people,and with an early full load to stimulate blood supply, healing and to prevent complications of
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 hip 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 happen 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 pierce the bottom 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 prosthetic TBS for the elderly patients
Two variants of the prosthesis:
- Single-pole prosthetics - when replacing only the femoral part of the joint
- Bipolar( total) prosthetics - with the replacement of the entire joint
Audit hip replacement
After endoprosthetics of the hipthe joint after some time may need a second operation.
To bring to it may be such reasons:
- Wear of the endoprosthesis, which causes it to stick and hang loose( the head can dislocate and exit the acetabulum
- Fracture of the prosthetic 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 revision operation
- , but on the other hand the assembly foot is less durable than the cast product
- . Bone destruction:
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, an
bone graft may be needed The surgery for hip replacement is more expensive than the primary operation by more than 50%
Rehabilitation after endoprosthetics of
After endoprosthesis replacementhip joint to rehabilitation start from the first day of .
The terms of rehabilitation depend on:
- Methods of fixing the prosthesis
- Conditions of the patient and his age
- Pain and complications
More information on hip joint rehabilitation after endoprosthetics is in the next article.
In conclusion - a positive story in support of elderly people who received severe trauma - a fracture of the neck of the hip 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 motion
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:
- "foot pump" - movement of the foot up and down several times( this exercise should be done throughout the rehabilitation period);
- short-term tension of the anterior hamstrings;
- shortening the buttocks and holding them in this position for five seconds;
- sidetracking and returning to the starting position of the operated leg;
- leg bend in the knee with heel support;
- rotation of the foot of the operated leg clockwise and counter-clockwise;
- of the raised 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
For the prevention of 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 a 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, more time is given to walking, observing the following rules:
- Walking is recommended not more than 30 minutes at a time.
- Going up the stairs, first put on the step a healthy leg, and only then operated.
- 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.
Basic exercises of exercise therapy that are added in this phase:
- 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.
- Lying on the back:
- alternating the legs to the sides;
- 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.
Gradually the duration of walking is 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.
At first, the
rehabilitator will help 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, after hip replacement, more than three months have elapsed, and if walking in the operated leg causes 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.
There are several variants of prostheses and methods of conducting the operation. For example, the replacement of TBS may differ in the degree of intervention:
- Partial replacement - single-pole prosthetic TBS.It is almost always performed by a mini-invasive method.
- Total hip arthroplasty - complete replacement of the joint and bone parts( bipolar prosthesis TBS).In this case, during surgery, both the cavity and the head are changed. Total hip arthroplasty can be performed by a mini-invasive method or traditional surgical method.
Depending on the technology by which the prosthesis is attached to the bone, distinguish:
- The cementless fixation of the endoprosthesis - the fixation of the prosthesis occurs due to the growth of bone tissue in the structure of the implant.
- Cement anchorage of the endoprosthesis - is carried out by fixing both constituent parts of the prosthesis with a special cement solution.
- Hybrid( combined) method - the method when the cup is fixed with cementless technology, and the foot - with cement.
Now more and more clinics offer their clients endoprosthetics of the knee joint using computer-based navigation technology. With the help of infrared rays and sensors, the image of the replaced joint is constructed on the computer monitor, which allows you to accurately determine the desired position of surgical instruments. Use in the operation of computer navigation allows you to accurately compare the bones and elements of the prosthesis, which is not easy to do with a normal operation.
When an operation is necessary
Endoprosthetics are a complex process, recovery after it is long, which is why operation can only be assigned in exceptional situations. Surgery on the hip joint is performed:
- with Bekhterov's disease;
- non-fissile hip fracture;
- for arthritis or arthrosis;
- withers the tissues of the femoral head.
Only a physician can prescribe an operation to replace a joint, as a rule, it does this only when no other conservative methods of treating the disease-causes have produced a good result.
Replace the hip joint in the event that other methods do not have any positive effect. Especially if the patient suffers from regular significant pain, can not self-care for themselves.
For thinking and weighing the situation, a certain amount of time is given if the patient has arthrosis of TBS.In case of a fracture of the femoral neck, the decision on prosthetics should be taken within a few hours after the injury. With necrosis of the head of the thigh, surgical intervention should be immediate, as this is not only a rapidly developing process, but also extremely painful.
Before carrying out the operation on prosthetics, thorough preparation for hip arthroplasty is needed. A person is assigned an X-ray examination, during which the doctors determine the degree of deterioration of the TBS according to the pictures.
When deciding whether to conduct an operation, possible contraindications, the condition of the patient and his age category are taken into account. To assess the condition, a physical examination is performed, and tests are assigned.
In addition to the above studies, before surgery to replace a hip prosthesis, it is necessary:
- To cure chronic or acute inflammation in the body, as they increase the possibility of infection of the implantation zone.
- Call the dentist to resolve all problems associated with dental diseases.
- In case of obesity, you need to consult a dietician. During excessive stress on the artificial joint, the risk of blood clots or inflammatory processes increases.
- Buy crutches with armrests. After endoprosthetics, a new joint requires a long time of rehabilitation and careful handling. During several months, the full load on it is prohibited.
The hospital is required to arrive the day before the scheduled operation. During the operation, the patient is under anesthesia - general or spinal( during it the person is awake, but his lower half of the body is anesthetized and loses sensitivity).
During the procedure of hip replacement, the operation is performed in several steps:
- An anesthetic or anesthetic is injected, then the surgeon makes an incision and removes the affected joint.
- An artificial joint is fixed and fixed. This happens with the help of a special cement or cogs. When large defects occur in the bones, bone screws are used.
- The completion of a surgical intervention is the examination of a new joint( before suturing).The surgeon must make sure that the prosthesis is securely attached to the bone and to check if there is a dislocation of the prosthesis when performing various amplitude moves( movements and turns).
Surgery for endoprosthetics is performed in several stages of
. Because during the operation for implantation of artificial tuberculosis the wound may accumulate liquid, drainage is connected, the incision is covered with a soft cloth. In general, the operation lasts up to two hours.
In a hospital, you will have to spend 10 to 12 days after the operation. The fact is that the doctor needs constant monitoring of the behavior of the new joint and the reaction of the patient's body in the course of adaptation to the object injected into the body. In addition, the pain symptoms and swelling are normal after the operation, so measures are needed to eliminate the symptoms( the patient should be anesthetized and antibiotics the first days).
For normal passage of the recovery process after arthroplasty of the joint, the leg should be correctly fixed. For these purposes, between the legs put a cushion, when the patient lies( we recommend to find and see a video from the Internet to understand how to properly place the roller).
From the second day after prosthetics it is possible:
- to sit on the bed;
- to carry out a complex of static exercises for the feet;
- to carry out respiratory gymnastics.
If complications after hip arthroplasty do not occur, then on the third or fourth day the patient is allowed to walk a little with the help of crutches or an arena. The day before discharge from hospital, the stitches are removed. At the time of writing, the patient can already climb and descend the stairs with crutches. After 5-6 weeks, the patient already leaves the crutches and starts using the cane.
After discharge for another six months, rehabilitation procedures are needed - massage, special diet, physiotherapy, exercise therapy( you can practice in the gym with a coach or at home on a video that the doctor advises).
Repeated intervention of
In some cases, the replacement of TBC after a while is not good for use and re-revision hip arthroplasty may be necessary. Replace the prosthesis may be necessary in the case of development of infection in the tissues surrounding the prosthesis, or if there was a destruction of bone tissue at the site of its fixation. Rehabilitation after such an operation can be delayed( at least a year).
In our time, endoprosthetics of TBS and re-prosthesis are quite common. After it, a person has the opportunity to get rid of constant pain and again lead a normal lifestyle.
Disability after prosthetics
Disability after endoprosthetics of TBS - it sounds like a sentence. But usually a disability in the case of a prosthesis is given for a short period of time, until the functionality of the limb is restored. For confirmation of disability, certain documents are required, after registration in relevant organizations, a person is included in the category of people under social care.
If, after the set time after treatment and rehabilitation, the examination at the doctor determines that the functionality of the leg is restored, then the disability will be lifted, if the joint does not come to the proper norm - the disability will be prolonged and the treatment will continue.
Choosing a clinic and the cost of
For the operation to replace TBC, it is better to select not a "professor with awards" but a practicing orthopedist who has gained sufficient experience in carrying out hundreds of such operations( at least five years in the field of orthopedic prosthetics).There are enough such doctors in Russia. If you decide to operate abroad, we recommend that you contact the German specialists, as they are famous in the field of endoprosthetics. Choose a clinic not for advertising videos and photos, but reviews of patients, qualifications and experience of specialists.
The prices for an operation of this type in Germany are too high
The cost of surgery for endoprosthetics in private clinics is approximately 230,000 rubles, but this amount can vary depending on how much the hip joint endoprosthesis costs. It includes the preparation of the patient before the operation, the process of hip replacement and the management of the patient after the operation. During the initial rehabilitation, the patient remains in the ward for several weeks. The cost of services for endoprosthetics does not include the treatment of possible associated pathologies. The total cost varies depending on the price of the prosthesis itself.
More information about endoprosthetics can be found in the video:
Elena, 27 years old
I never thought that I could face the problem of joints. All the same young, active always was. And then a couple of years ago began to constantly get dislocations, it became impossible to walk on his heels - it hurts. I went to the doctor and heard a disappointing diagnosis - dysfunction of the left hip joint - he just fell apart into pieces. The choice I had was not great - either a disability or an endoprosthesis. By not knowing, I thought that the difference is small - once put the prosthesis in the leg, then I will forever be disabled. But it turned out that I was an alarmist. The operation went well. Quickly recovered. And now I do not remember that I have a foreign object in my leg.
Grigory, 55 years old
The operation to replace the joint for the prosthesis went well. From 3 days they allowed me to walk with a stick. After 15 days, the seams have already been removed. A month later I started walking alone. In a year the leg was completely restored and the cane is no longer needed.
Leo, 61 year
If you need to put a prosthesis - put it! Do not be afraid. Now this operation is very common, and doctors have worked it to the smallest detail. I put a prosthesis in Moscow. The operation took only half an hour. Already on the fourth day I went with knuckles down the corridor.
Lisa, 37 years old
Mom last year did not successfully fall and got a fracture. A simple gypsum, unfortunately, it was not done. They made endoprosthetics. Honestly, they were already tuned to the fact that it would remain lying - after all, the turning point is heavy and the age makes itself felt. But, hooray, everything turned out. Has transferred or carried mum operation easily. She never complained of pain. Of course, the recovery was not as fast as that of the thirty-year-olds - it was necessary to collect patience in a fist. For several months she went with a walker. Then they switched to a wand. She limped for a long time, since ligaments were partially cut at the surgery site. But when they recovered, the limp passed.
Endoprosthetics of the hip joint.https: //www.youtube.com/ watch? V = GAdloYjh-Uo
Operation for hip replacement. Feedback of the patient
http: //endoprotes.com/ Operacija-po-za. ..
My name is Oksana, I am 41 years old. I had a surgery 3 weeks ago to replace the hip joint. Everything went great. Rehabilitation was wonderful. I decided to leave without crutches. And I succeeded. Many thanks to my coach Sergey, who put me on his feet wonderfully. All perfectly. I hope that in 6 months I will already go in for sports and lead an active lifestyle