Endoprosthetics – a surgical intervention that is required for a person with severe destruction of the hip joint. This is the only way to return to an active lifestyle, to fulfill their professional duties and even play sports. According to patients, only after hip replacement they were able to completely get rid of pain at rest and when walking, limping and morning stiffness of movements.
Features of arthroplasty
In severe lesions of the hip joint (TBS) with inflammatory or degenerative-dystrophic pathology, conservative methods are ineffective. A person gradually loses the ability to move independently. And it is impossible to get rid of pain for a long time even with the help of potent analgesics. In such cases, patients are shown endoprosthetics – replacing the damaged joint with TBS implant.
At the stage of preoperative preparation, the patient takes drugs prescribed by the surgeon, is engaged in physical therapy and gymnastics. Due to muscle strengthening, replenishment of vitamins and minerals, postoperative complications can be avoided. The rehabilitation doctor teaches the patient in advance walking on crutches, lifting from a sitting and lying position, and skills in deep diaphragmatic breathing.
The operation does not last long, and immediately after it begins a long rehabilitation. The patient constantly develops the operated leg, walks a lot to form the lost correct motor stereotypes. After about 3-4 months, the functional activity of TBS and legs is fully restored.
Advantages and disadvantages
As with any surgical intervention, TBS endoprosthetics have their own advantages and disadvantages. Thanks to innovative technologies, operations are increasingly carried out with minimally invasive methods, with minimal damage to the skin and underlying soft tissues. The postoperative suture after such an intervention is small. It heals quickly, without leaving scars and scars on the skin.
But the main “plus” of endoprosthetics is the elimination of pain, swelling, limitation of mobility preceding complete immobilization. After an operation performed by the minimally invasive method, patient recovery is much faster. What can be attributed to the disadvantages of arthroplasty:
- risk of postoperative complications;
- long period of rehabilitation;
- the need to replace the endoprosthesis in 10-15 years.
Another minus is the relatively high cost. After contacting the regional authorities, the patient is queued for free endoprosthetics. But the operation is in demand, it takes a long time to wait for a call. Therefore, many patients prefer to pay for the installation of an artificial joint on their own in clinics in Russia, the Czech Republic, and Israel.
Why endoprosthetics may be required
Orthopedists, rheumatologists, traumatologists always take into account the likelihood of postoperative complications, therefore they often try to cure the pathology that affected TBS with conservative methods. Such therapy is not always successful, and surgery is recommended for the patient. In what cases is endoprosthetics indicated:
- aseptic necrosis of the femoral head;
- dysplastic coxarthrosis;
- femoral fractures;
- the formation of false joints;
- acetabular deformation after injuries;
- chronic forms of arthritis, including rheumatoid polyarthritis;
- Ankylosing spondylitis with a lesion of the hip joint;
- complete or partial immobilization of the joint – ankylosis;
- Congenital femoral neck fractures.
Irreversible changes in the hip joint are characteristic for pathologies of 2-3 severity. With severe destruction of TBS, doctors recommend that you do not spend time pre-unpromising conservative treatment, but immediately establish an endoprosthesis.
About expectations from surgery, prostheses and specialists
Endoprosthetics will be successful if the right choice is made for the relevant domestic or foreign medical institution. Its staff should be staffed with highly qualified surgeons who perform complex operations daily. In good clinics, there are always experienced rehabilitation doctors who will help the patient quickly restore the operated leg. You need to spend enough time to study the reviews of people who have had hip arthroplasty.
Mandatory consultations with specialists of the clinic, a conversation with the surgeon. After studying the diagnostic results, additional studies may be required to determine the type of implant necessary for the patient. Endoprostheses consist of the following components:
- a cup replacing the acetabulum of the pelvic bone. The item is made of ceramic or polymeric material;
- a metal ball-shaped head covered with a layer of ceramics, providing a smooth glide of other structures of the artificial joint when walking;
- a metal leg imitating the neck and upper third of the femur.
The materials used in the manufacture of the implant are quite inert, compatible with the tissues of the human body. Previously, unipolar arthroplasty was often practiced. This is the name of the operation, during which only the destroyed head of the femur is replaced. Due to the high probability of further damage to the acetabulum, bipolar prosthetics have recently been resorted to. An implant is installed that replaces all parts of the TBS. These prostheses are firmly fixed in bone structures, perfectly adapt to subsequent loads during movement.
Methods of fixation of endoprostheses
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The effectiveness of the surgical intervention is affected not only by the type of endoprosthesis, but also by the way it is fixed. Indeed, on how firmly it will be adhered to bone tissues, the term of operation and the quality of service, including the fulfillment of support functions and ensuring the necessary range of movements, depend.
Despite the fact that the fixation method is determined in advance, the surgeon can change his mind when examining the surgical field.
|The method of fixation of the endoprosthesis of TBS||Characteristics|
|Cement||During the operation, a special biological glue is used, after hardening, it provides a strong attachment of bones to the elements of the endoprosthesis|
|Cementless||The implant is fixed using special devices, the design of which provides for multiple small protrusions, grooves, bumps, holes. Over time, they are filled with bone tissue. Thus, the prosthesis becomes one with the bone structures|
|Mixed||The fixation combines cement and cementless methods. Using cement, the leg is fixed in the bones of the thigh. A cup is set by screwing into the acetabulum|
The disadvantage of cement fixation is the high temperature during hardening of biological glue. Under its influence, bone tissue can be damaged, and the endoprosthesis can shift to the side of the pelvis. The advantage of this method of attachment is the faster rehabilitation of the patient than with cementless fixation. Therefore, surgeons often prefer a combination of cement and cementless endoprosthetics.
What happens during surgery
The initial stage of arthroplasty is anesthesia. Epidural anesthesia and general anesthesia are practiced. For elderly patients suffering from chronic pathologies, the first method is preferable. Under epidural anesthesia, a person is fully conscious, but does not feel any pain. He hears the tapping of hammers, the sound of a drill, the conversations of surgeons involved in the installation of an endoprosthesis.
After access to the surgical field, the doctor opens the joint capsule, brings out the head of the femur and performs its resection. After modeling the bone, the surgeon processes the acetabulum, removing the remaining cartilage. At the final stage of the operation, the implant is fixed, sutured, and active suction drainage is installed.
Complications after replacing TBS with an implant are rare.
Sometimes an infectious process develops with the accumulation of purulent exudate due to the penetration of streptococci, staphylococci, pathogenic fungi into the postoperative wound, and activation of herpes viruses. Possible blockage of a blood clot by a blood vessel, impaired blood circulation in a specific area of the leg. To prevent such complications, patients are treated with antiseptics during the treatment of sutures, antibiotics and anticoagulants are taken inside.
Cost of operation
The cost of the operation is set by a domestic or foreign clinic. It is calculated individually, taking into account the severity of the pathology, the price of the endoprosthesis and the materials used during the operation:
- unipolar endoprosthetics – from 25000 to 240000 rubles;
- primary total hip arthroplasty – from 23000 to 250000 rubles;
- revision hip arthroplasty – from 20000 to 350000 rubles;
- closed reduction of dislocation of the endoprosthesis head – from 4000 to 25000 rubles.
Also takes into account the cost of laboratory and instrumental studies, daily stay in a medical center. The price will increase if rehabilitation takes place in this clinic, and not at home.
According to doctors, the vast majority of patients with the results of surgical treatment are enough. All functions of the hip joint are restored, limping, limb shortening, limitation of abduction and internal rotation of the thigh characteristic for its damage disappear. Further rehabilitation with a gradual increase in loads helps to tidy up the previously atrophied muscles of the thigh, buttocks, lower leg. After installing the prosthesis, the likelihood of bilateral TBS damage due to improper redistribution of loads is reduced.
Endoprosthetics is often the only way to get rid of the pain that occurs during the day and night hours, worse when walking. Now patients do not deny themselves long walks in the fresh air, traveling, working in the garden.
Restrictions are only those sports and movements that are associated with power loads on the operated leg. Due to lengthy physical therapy and gymnastics classes, not only the physical, but also the psychological state of former patients is normalized. Their ligaments and muscles become stronger, and many chronic diseases recede as a result of improved blood circulation.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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