Hip replacement: indications and contraindications

Эндопротезирование тазобедренного сустава: показания и противопоказанияArthroplasty is a surgical operation during which the primary is destroyed by disease or trauma, the joint is replaced by high-quality artificial prosthesis. Arthroplasty is almost the only way to restore mobility of the limb in the event of extensive damage to the hip joint. The endoprosthesis of the hip joint most often set for patients suffering from degenerative-dystrophic diseases which are most severe in older people. Given the fact that degenerative joint disease is rapidly getting younger, quotas on operations for joint replacements increases every year.

It is worth mentioning that the main difficulty of a hip joint prosthesis is in the age of the patients. The fact is that young people are easier to survive such an operation and the rehabilitation process is considerably reduced, since the body has a lot of reserves for recovery. Older people, for whom this operation is shown more often, experiencing it is much harder, because the processes of aging reduce the body’s ability to regenerate. Older patients require a long course of rehabilitation.


When shown a hip replacement?

Эндопротезирование тазобедренного сустава: показания и противопоказания

It is immediately noted that the surgical treatment of the joint is indicated only if conservative methods of influence do not give a positive result. To determine the extent of necessary surgery, the doctor takes into account the following features of the disease.

  • General medical history of the patient. In the course of collecting history record information regarding sex, age, General health, somatic indicators, course, and speed of progression of the underlying disease, if any.
  • The change in the joint. As a rule, the change in the joint is based on x-rays.
  • Residual functional ability of the joint. Assessment of the severity of functional disorders of the joint allows you to determine whether you need the prosthetic joint and will require surgery, the replacement of part of the pelvic bone.
  • Assessing the intensity of pain in a damaged joint. Often an indication for surgical intervention is the inability of the patient to the slightest change in body position, which is a consequence of intense pain in the joint at the slightest movement.
  • In addition, the physician should evaluate the overall clinical picture, because sometimes the intensity of the symptomatic manifestations of the damage is not to the stage of severity of joint destruction when conducting x-ray examination.

    Comparison of the clinical picture described in the medicine cases of the occurrence of a disease allows you to determine how necessary hip prosthesis in a particular case. Often to assess the possibility of surgery doctors use a special scoring system, developed by Harris, which involves a comprehensive assessment of the patient’s condition.

    If the overall rating on the system of Harris is less than 70%, the surgical operation in which an artificial prosthesis will be inserted in place of the damaged joint. Taking into account all the characteristic features of damage assessment in the joint, it is possible to identify a number of diseases and pathologies for which it operation prosthetic hip joint.

    Эндопротезирование тазобедренного сустава: показания и противопоказания

    Pathological change in the head of a patient with osteoarthritis of the joint

  • Osteoarthritis of the hip in the 3rd and 4th radiological stage.
  • Aseptic neurosis of the condyles of the femur with marked deformity of the limb.
  • Aseptic necrosis of the femoral head with severe deformity of this region.
  • A pronounced pain syndrome and dysfunction of the limb at the full failure of conservative treatment.
  • The defeat of the hip joint in rheumatic diseases.
  • Deformation of the hip joint with severe protrusion of the acetabulum.
  • Muscle contracture.
  • Fibrous ankylosis.
  • Bone ankylosis.
  • The shortening of the legs due to damage to the joint.
  • Strong traumatic changes of the joint with impairment of its function.
  • In some cases, the prosthetic joint is the only reliable way of removing the patient from prolonged, intense pain that persist at rest and with movement of the limb, which is especially important when medications getting rid of pain do not bring any positive effect.


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    Contraindications to arthroplasty

    Despite the fact that the replacement joint is in some cases the only way to alleviate the patient’s condition, this procedure, like any surgical intervention, has a significant number of contraindications. Complications after the procedure, usually develop in those patients who had specific contraindications to a prosthetic hip joint.

    Any post-operative complications can be pre-calculated and is minimized, if the advance was detected deviations. In some cases, the presence of certain factors can lead to the fact that joint replacement will not give the supposed results, but is dangerous to human life. You can highlight some of the most common factors that may make surgery inadvisable.

  • Somatic abnormalities. In patients with concomitant severe chronic diseases, postoperative complications are more often. In addition, significantly increase the risk of adverse effects with the introduction of anesthesia and other problems during operation.
  • Mental disorder. The number of patients with mental disorders, are not able to correctly assess the risks associated with the operation, and adhere to the postoperative treatment and rehabilitation.
  • The presence of active foci of infection. As contraindications may be regarded as foci of infection located in the vicinity of the affected joint, and those that are located at a considerable distance.
  • Multiple deep soft tissue damage. The presence of such damage is considerably difficult to carry out postoperative rehabilitation, and sometimes makes it impossible to comply with the postoperative regime that can cause certain complications.
  • In the presence of certain conditions, only a qualified physician can correctly evaluate the possibility of surgery and the risk of developing a complication.


    Variety of operations of the pelvis

    Эндопротезирование тазобедренного сустава: показания и противопоказания

    How is joint replacement of the pelvis: the progress of the operation

    Given the degree of joint disease and the overall clinical picture in different cases, it may be used in a prosthesis of a different configuration. In addition, you need to consider that any artificial prosthetic joint has a life, so eventually you may need surgery. There are four basic types of operations to replace hip joints.

  • Partial hip replacement. When surgery is the removal of part of the articular bed, the neck and the femoral head. In this embodiment, the surgical treatment completely changes the hip joint to the prosthesis. Articulate the bed, as a rule, rekonstruiruet of materials such as ceramics and metal. Attached to a glue or pins. The prosthesis of the femoral head is introduced into the femoral bone using a special pin. After such an operation requires a long course of rehabilitation.
  • Total joint replacement of the hip. This type of prosthesis the hip joint is one of the most complex, as it involves a full hip replacement. Total hip replacement is a necessary measure in the case when, during the course of the disease of the hip bone and articulate the bed was subjected to total destruction, so to restore them is not possible. In addition, total joint replacement may be appointed in the case, when the patient’s weight exceeds the norm and partial joint replacement does not guarantee that the prosthesis will be able to withstand. In addition, total hip replacement may be appointed under strong deformations of the femur and the articular bed.
  • Surgery to replace the articular surfaces. In some cases, can be assigned to an operation aimed at easy adjustment of joint damage. Such an operation is possible only in the case that erosion only affects the surface of the bed and the articular head of the hip bone. Surgical exposure in such transactions is minimal and lies solely in the strengthening of the articular surface of the bed and the femoral head due to the artificial materials.
  • Revision hip arthroplasty. As a rule, this operation is assigned when already inserted prosthesis has exhausted the period of his service and needs to be replaced. In some cases, revision surgery of the hip joint can be assigned before the end of the service life of the artificial joint in cases when the prosthesis cease to function due to unforeseen circumstances, for example, damage to the prosthesis during the fall. Re hip replacement requires the doctor’s high level of professionalism, as the replacement of old prosthesis is very laborious work that requires utmost care.
  • Often repeated replacement of the hip joint is held in the case of development of such complications as infection of the installed implant.


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    Types of implants

    Currently, there are over 200 varieties of implants that allows to choose the most appropriate configuration option for each specific case. Any artificial model of the joint is high-quality simulation of the natural hip bone and joint cartilage, and it has a rounded head simulating the head of the hip bone and the structure of the acetabulum. By way of attaching all the options in hip arthroplasty can be divided into 3 main types.

  • Prostheses with cement fixation. In this embodiment, during the operation used a special bone cement, which allows you to securely fix the implant.
  • Prosthesis with cementless fixation. In this embodiment, the surface of the denture is covered with a special porous material, which leads to the fact that bone tissue begin to grow inside of the implant, so the bone and the prosthesis after a certain time become one. In addition, pezzementi fastening method applies a pin connection.
  • The prosthesis is combined with a variant of fixation. In this embodiment, the portion of the prosthesis, simulating the acetabulum, is attached with bone cement, while the part that simulates the femoral head, fixed cementless method.
  • Эндопротезирование тазобедренного сустава: показания и противопоказанияThe hip prosthesis may be made of ceramics, titanium, plastic and other durable materials that can withstand the required load. Proper selection of hip implants to reduce the risk of the occurrence of any complications.

    The thing is that the hip joint prostheses of a particular type have their own specific characteristics, explained by the fact that individuals have their peculiarities of structure of the joint, so that the result was as good as possible, you need to choose the option that will best suitable for particular person.


    The operation

    Any surgery has its own peculiarities of preparation of the patient for the procedure and specific operation. First and foremost, the patient should be admitted to the hospital, where he must carry out x-rays and take tests to assess General condition.

    Prior to surgery the patient must undergo treatment, if he has acute or chronic inflammation caused by infection. Preparation for surgery is extremely important. Mandatory is a visit to the dentist to eliminate dental caries and other diseases of the oral cavity. The thing is that because of an existing infectious focus can develop different kinds of complications. In some cases, patients with a significant amount of weight should consult a dietician and lose a certain number of kilograms. No harm will advance preparation of the crutches that may be required during postoperative rehabilitation.

    Operation installation of the hip prosthesis can be performed under General anesthesia and with the use of spinal anesthesia in which the anesthetic agent is injected into the spinal cord, allowing the person though and is in a state of awake, but not feeling the lower limbs. After the introduction of anaesthesia the operation is performed in several stages.

    Эндопротезирование тазобедренного сустава: показания и противопоказанияFirst, the patient is placed on the side, in the lateral thigh incision is made the skin and soft tissues. Through the uncovered area, the surgeon makes the removal of the damaged parts of the joint. Next is the installation of an artificial hip joint, for fixing which is used a special glue or cement, or mechanical action. Further, an assessment conducted by implantation of an orthopedic surgeon, which make sure how firmly seated prosthesis.

    To evaluate podiatrist foot performs a number of movements that allow us to estimate the mobility of the legs and the possibility of dislocation during movement. During the operation, the emitted excess blood and fluid are removed through drainage. Typically, the total length of the operation is not less than 2 hours.



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    Possible postoperative complications

    Postoperative therapy and rehabilitation plays a very important role, therefore, all patients are required to strictly follow all the recommendations of doctors for at least 6 months. However, the most important are the first week after surgery, as it may appear complications that can slow the healing process and can even nullify the results of the operation.

    The first week after the surgery the patient usually spends in the hospital, as there is an acute inflammatory process, after the intervention. The patient at this time, the prescribed physical rest.

    Эндопротезирование тазобедренного сустава: показания и противопоказанияOn the 2nd week of the operative wound with a favorable course of healing shrinks and heals rapidly. This period can be assigned special exercises with minimal load, which perform holyblue function for the muscles. Usually, this easy motion foot, but a full-fledged sport is contraindicated.

    In the period from 3 to 7 week starts on restoring the functionality of the joint, i.e. the body gets used to it. During this period, movement is possible only with crutches. To speed up the recovery process used physiotherapy with a gradual increase in load and the degree of complexity of the exercises. During this period, many patients feel well enough but you need to remember that sport and loads must be metered.

    During the period from 7 to 9 a week, there are processes of healing of tissues of bones and hip prosthesis, which makes the structure one. During this period, the sport involving heavy loads, must be excluded.

    From 9 to 12 a week there is a complete adaptation to the prosthesis and the person is able to walk normally without crutches. Despite the fact that the official rate of rehabilitation comes to an end still a sport involving heavy loads should be excluded for at least 8-12 months. During this period the patient must visit a physiotherapy. In addition, a positive impact on the condition of the body any water sport.

    Possible postoperative complications

    Surgeries to replace the hip joint have long run planned, so many possible complications can be seen on time by doctors that can effectively treat them or to stop. However, despite the fact that many surgeons have many years of experience performing such operations, still there are cases when there are postoperative complications. The most common complications include:

    • limitation of joint mobility;
    • the appearance of osteophytes;
    • inflammation of the wound, surrounding the artificial joint;
    • fracture of the bone around the artificial joint;
    • dislocation of the prosthesis;
    • bruising;
    • thrombosis.

    The appearance of severe swelling around the joint, increased pain and clear signs of inflammation are cause for concern and consultation with the doctor about further treatment.