Replacement of the hip joint with an artificial implant

Замена тазобедренного сустава на искусственный имплантат

Hip replacement or arthroplasty is a surgical operation for partial or total joint replacement with an artificial prosthesis. This prosthesis is used in cases where the joint is severely damaged, pain is strongly expressed, motor functions are impaired, and medication does not give results.

Such surgery leads to a significant reduction of pain in the joint or even its total disappearance. The operation is planned after a full examination and evaluation of the complexity of the surgical intervention. In addition to a complete medical examination, the patient must necessarily pass to the study of urine and blood, and an x-ray of the lungs and take readings of the electrocardiogram.

During the fitting, there is a risk of blood loss, so some time before the surgery, the patient gives blood to reduce the risks from donor transfusions. The surgery is performed under General anesthesia. For many patients, joint replacement is often the only possible method of recovery of motor function of the limb.


Indications for surgery

It often happens that the endoprosthesis is assigned to people with progressive degenerative arthritis and degenerative disc disease. The bulk of these patients are elderly, since these diseases develop with age. But it is possible that these diseases may arise as a result of injury or congenital anomalies of the joint.

In the implantation of a hip joint may need and people with severe necrosis or fractures of the hip bone. Bone necrosis is often the result of systemic diseases or post-surgical complication of kidney transplantation. Destructive action on bones can have some drugs and alcohol.

Замена тазобедренного сустава на искусственный имплантат

Irreversible changes in the bone are the indications for surgery

In the case of the innate inferiority of the hip (dysplasia), in which the bone is originally developed and is functioning incorrectly (which leads to its rapid wear), there is no other treatment except surgery for replacing the implant. In normal development and the absence of any injuries to the hip joint has a smooth surface. This allows the person to make movements without discomfort and pain. At pathologies of the head of the joint wears out, causing pain when walking or other foot movements.

As with any surgical procedure, there is the risk of complications after surgery. There are a number of cases where the arthroplasty is inappropriate:

  • the fragility of the bones, which will not allow to hold the implant;
  • damage to nerve endings in the joint;
  • instability of joint;
  • underdevelopment of the bones;
  • rheumatoid arthritis;
  • osteoporosis;
  • cardiovascular diseases in decompensation;
  • acute diseases of lower extremities vessels;
  • the presence of a purulent focus of infection;
  • infectious diseases of the joint;
  • disorders of the psyche.
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Diagnosis of the disease, types of arthroplasty

Замена тазобедренного сустава на искусственный имплантат

Patient implanted in a healthy part of the bone pin with an artificial head

The main methods of diagnosis of disease of the hip joint include:

  • Clinical examination: pain under load and motion, asymmetry and limitation of movement.
  • A series of x-rays, which are made in different projections.
  • Ultrasound.
  • Magnetic resonance imaging.
  • The method of radiographic contrast studies (angiography).
  • Bone scintigraphy (isotope study).
  • Diagnostic puncture.
  • Analysis of blood and synovial fluid. Allows to detect the presence of inflammatory and other pathological processes.
  • Surgery prescribed after a complete picture of patient status and selection of the prosthesis. There are 2 types of replacement:

  • Total joint replacement (head and acetabulum).
  • Hemiarthroplasty — SPST replacement. Replaces only the femoral head.
  • Full or total joint replacement involves replacement of all components of the joint with artificial. With thigh support is transferred to the stem of the implant and through the head on vertline component that is installed on the site of the destroyed acetabulum. A person can move the leg (the joint) due to the interaction of artificial components of the prosthesis.
    Замена тазобедренного сустава на искусственный имплантат
    Artificial hip joint by total replacement is mounted and fixed cement, cementless and combined method. Cement method involves filling of the bone cement of the space between the stem of the implant and the internal cortical layer. Cup of cement for fixing perimeter has ribs, which increases the adhesion to the cement.

    Cementless fixation of the prosthesis is due to the ingrowth of bone tissue into the prosthesis, which for this purpose has a rough surface after the implant is implanted into the bone by way of tight fit. The combined method of installation of the prosthesis to his leg is fixed with cement and the Cup is uncemented. SPST substitution is most often used after femoral neck fractures in the elderly. The prosthesis is established as a cement and by the way it is seated. This surgery restores the ability to move on their own, but due to the fact that the head of the implant directly affects the acetabulum, often when walking there is pain.


    Types of hip endoprostheses

    Medicine has approximately 60 different types of implants, which differ by the type of design and materials of manufacture. But any prosthesis consists of 3 components:

    • plastic Cup;
    • the metallic ball which substitutes the femoral head;
    • leg — metal rod for durability of the prosthesis.

    Замена тазобедренного сустава на искусственный имплантат

    X-ray image depicts the result of the operation to replace the joint

    The artificial joint is made from materials that do not harm health and biologically compatible with the human body. Those materials that interact with each other in the prosthesis, called a friction knot:

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  • Metal-plastic. A good and reliable budget option. Such an operation for a hip replacement is recommended for the elderly, as the plastic in the prosthesis because of the increased motor activity with the young people quickly wear out and require re-operation.
  • Ceramic-on-plastic. Head of endoprosthesis made of ceramic composite or aluminum, and the Cup is made of plastic. Acceptable abrasion resistance, but, as in the 1st variant, the plastic wears out quickly.
  • Ceramics. Prosthesis made of a composite ceramics pink. This material is resistant to wear and biologically compatible with the body. In addition, the ceramics allows to produce head with a larger diameter, which gives the opportunity to increase the range of motion in the joint. The disadvantages include fragility (the probability of a split) and high cost.
  • Metal. The most expensive and reliable form of construction of the prosthesis of the existing ones. It is recommended for implantation in young and active people.

  • Rehabilitation and complications after hip replacement

    After surgery, the patient spends several hours in intensive care and then, if there are no complications, he was transferred to the ward. In addition to pain medications, antibiotics, anticoagulants and fibrinolytic. Through the day the patient is removed and the catheter removed postoperative drainage (if it was installed). Make a series of x-rays to check the correct installation of the prosthesis. If the images confirm the success of the operation, on the same day, the patient should start the recovery process: to change position in bed (more to sit than to lie down), to take a few steps, leaning on crutches in the presence of a physician.

    The stay in hospital exceeds 10 days. During this time the patient needs to learn how to get out of bed and move around. The post-operative period takes several months. The first exercise after the surgery, start to do the next day (in sitting position).

    You should be prepared for the fact that the recovery in the first weeks will be accompanied by a mild pain in the hip. Of great importance in the postoperative period plays a therapeutic exercise. For each patient, select exercises that help to normalize movements of the limbs and strengthen muscles.

    On discharge from the clinic, the doctor will give a full description of the contraindications and exercises that you can do yourself.

    The danger that may lie in wait immediately after the surgery is infection. For the prevention prescribe a course of antibiotics. To avoid thromboembolic complications, it is recommended to perform exercises for lower leg, wear a special stocking, and also to carry out preventive treatment with anticoagulants. It is impossible to restart the joint, as excessive pressure may cause dislocation or fracture of the implant (fracture). This is especially true for overweight people.
    Due to the presence in the body foreign body fracture may be near the implant joint. This reaction occurs for the following reasons:

    • an allergic reaction to the material of the endoprosthesis;
    • improperly installed implant;
    • improper cementing.

    The most common complication, even after the full course restoration is the loosening or displacement of the prosthesis.


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    The cost of the operation

    The operation cost of the replacement depends on the type of implant, country where the medical institution and the value of its services. So to give a specific figure is impossible. For example, a hip replacement in Germany costs approximately 15,000 euros in Israel — 12,000 euros, in Russia — 3,000 euros.

    There are 2 ways how to pay for the cost of the operation: own funds and for the medical quota.
    In the 1st variant the patient fully pays for all the necessary operations. As for the 2nd option, there is a special government program to provide free high-tech medical aid (quota). To get it, the patient must collect the needed documents and to sign up for all in the health Department, which is located at the place of residence. Medical quota, the operation is performed free of charge. The cost of treatment and the prosthesis is covered by the state. As a rule, after the registration of all the document until the issue of quota, it takes about a year.
    After joint replacement, many are asking, as they now live on. Sometimes the prosthesis is much better than your own joint, which causes pain or restricts movement. You cannot lift weights, you need to monitor the weight to avoid hypothermia, in a timely manner to treat all infectious diseases, not to do sharp movements of the leg. Should be possible to reduce the load on the operated leg. We should not forget about the set of exercises that will keep muscles toned.