Hip replacement: indications and contraindications
Arthroplasty 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?
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.
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.
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.
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.
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
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.
Often repeated replacement of the hip joint is held in the case of development of such complications as infection of the installed implant.
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.
The 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.
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.
First, 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.
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.
On 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;
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.