Studies show that complications after hip replacement develop in 1% of young people and 2.5% of older patients. Despite the minuscule probability of developing negative consequences, they can affect anyone, and especially those who did not strictly follow the rehabilitation program.
Image of the position of the endoprosthesis in the human body.
Complications after hip replacement are caused by improper postoperative care and physical activity after discharge from the hospital. The second reason is the surgeon's mistakes. And third, this is an incomplete preoperative examination, as a result of which hidden infections (tonsils, cystitis, etc.) were not cured. The success of treatment is influenced by the qualifications of the medical staff, where the patient received high-tech medical care - surgical and rehabilitation treatment.
The pain varies, but there is “good” pain – after moderate physical activity. And there is a “bad” one, which speaks of problems that need to be urgently diagnosed.
Complication statistics as a percentage
Surgery to install a hip joint prosthesis is the only method that “puts” the patient back on his feet, relieves debilitating pain and limited ability to work, and allows him to return to health. physical activity. Unpleasant pathological situations associated with implantation occur infrequently, about which the patient should be informed. According to ongoing randomized controlled trials, the following data were obtained:
- dislocation of the head of the prosthesis develops in approximately 1.9% of cases;
- septic pathogenesis – in 1.37%;
- thromboembolism– 0.3%;
- periprosthetic fracture occurs in 0.2% of cases.
They develop not through the fault of the surgeon, but of the patient himself, who did not continue rehabilitation or did not adhere to a special physical regimen after the end of recovery. The deterioration of the condition occurs at home, when there is no close monitoring from doctors that was in the clinic.
Not a single orthopedic specialist, even with rich and impeccable work experience, can 100% predict how a particular body will behave after such complex manipulations on the musculoskeletal system, and give the patient a complete guarantee that everything will go smoothly and without incidents.
Differentiation of pain: normal or not
Pain after hip replacement will be observed in the early period, because the body has undergone a serious orthopedic operation. The painful syndrome during the first 2-3 weeks is a natural response of the body to a recent surgical injury, which is not considered a deviation.
Until the surgical injury heals, the muscle structures return to normal, until the bones and the endoprosthesis become a single kinematic link, the person will experience discomfort for some time. Therefore, a good pain reliever is prescribed, which helps to cope with early painful symptoms more easily and to better concentrate on treatment and rehabilitation activities.
Well-healing suture after surgery. It is smooth, pale and has no discharge.
Painful sensations must be differentiated and examined: which of them is normal and which is a real threat. This can be done by the operating surgeon. The patient’s task is to notify the orthopedic doctor if there are any uncomfortable signs.
Main risk factors
Surgical intervention does not exclude complications, and serious ones at that. Especially if mistakes were made during the intra- and/or postoperative period. Even small errors during surgery or during rehabilitation increase the likelihood of unsatisfactory hip arthroplasty. There are also risk factors that increase the body’s susceptibility to postoperative consequences and often become their cause:
- advanced age of a person;
- heavy concomitant disease, for example, diabetes mellitus, arthritis of rheumatoid etiology, psoriasis, lupus erythematosus;
- any previous surgical intervention on the “native” joint, aimed at treating dysplasia, femoral fractures, coxarthrosis deformities (osteosynthesis, osteotomy, etc.);
- re-endoprosthetics, that is, repeated replacement of the hip joint;
- local inflammation and purulent foci in the patient's history.
It should be noted that after hip joint replacement, elderly people are more susceptible to complications, and especially those over 60. In addition to the underlying disease, elderly patients have concomitant pathologies that can complicate the course of rehabilitation, for example, reduce resistance to infection. There is a reduced potential for reparative and restorative functions, weakness of the musculo-ligamentous system, osteoporotic signs and lymphovenous insufficiency of the lower extremities.
It is more difficult for older people to recover, but this can be done successfully.
Concept and methods of treating consequences
Symptoms of complications after hip replacement will be presented below in the table for better understanding. A quick visit to a doctor at the first suspicious signs will help to avoid the progression of adverse events, and in some situations, to save the implant without revision surgery. The more neglected it becomes clinical picture, the more difficult it will be to respond to therapeutic correction.
Dislocations and subluxations of the endoprosthesis
Negative excess occurs in the first year after prosthetics. This is the most common pathological condition in which the femoral component is displaced in relation to the acetabular element, resulting in separation of the head and cup of the endoprosthesis. Provocative factors are excessive loads, errors in the selection of the model and installation of the implant (defects in the placement angle), the use of a posterior surgical approach, and trauma.
Dislocation of the femoral component on x-ray.
The risk group includes people with hip fractures, dysplasia, neuromuscular pathologies, obesity, joint hypermobility, Ehlers syndrome, and patients over 60 years of age. Individuals who have undergone surgery on a natural hip joint in the past are also particularly vulnerable to dislocation. The dislocation requires non-surgical reduction or open method. If treated in a timely manner, the endoprosthetic head can be adjusted in a closed manner under anesthesia. If the problem continues, the doctor may prescribe a repeat operation to reinstall the endoprosthesis.
Paraprosthetic infection
The second most common phenomenon, characterized by the activation of severe purulent-inflammatory processes in the area of the installed implant. Infectious antigens are introduced intraoperatively through insufficiently sterile surgical instruments (rarely) or after intervention they move through the bloodstream from any problematic organ that has a pathogenic microbial environment (often). Poor treatment of the wound area or poor healing (in diabetes) also contributes to the development and proliferation of bacteria.
Discharge from a surgical wound is a bad sign.
A purulent focus has a detrimental effect on the strength of fixation of the endoprosthesis, causing its loosening and instability. Pyogenic microflora is difficult to treat and, as a rule, requires removal of the implant and re-installation after a long time. The main principle of treatment is a test to determine the type of infection, long-term antibiotic therapy, and abundant lavage of the wound with antiseptic solutions.
The arrows indicate areas of infectious inflammation, this is exactly what they look like on an x-ray.
Thromboembolism (PE)
PE – critical blockage of branches or main trunk pulmonary artery a detached blood clot that formed after implantation in the deep veins of the lower limb due to low blood circulation resulting from limited mobility of the leg. The culprits of thrombosis are the lack of early rehabilitation and necessary drug treatment, prolonged stay in an immobilized state.
This complication is dealt with quite successfully at this stage of medical development.
Blocking the lumen of the lungs is dangerously fatal, so the patient is immediately hospitalized intensive care unit, where, taking into account the severity of the thrombotic syndrome: administration of thrombolytics and drugs that reduce blood clotting, NMS and mechanical ventilation, embolectomy, etc.
Periprosthetic fracture
This is a violation of the integrity of the femur in the stem area with an unstable and stable prosthesis, occurring intraoperatively or at any time after surgery (several days, months or years). Fractures more often occur due to reduced bone density, but can be a consequence of incompetent development of the bone canal before installing an artificial joint, or an incorrectly chosen method of fixation. Therapy, depending on the type and severity of the damage, consists of using one of the methods of osteosynthesis. The leg, if necessary, is replaced with a more suitable configuration.
Implant failure occurs very rarely.
Sciatic nerve neuropathy
Neuropathic syndrome is a lesion peroneal nerve, part of the structure of the greater sciatic nerve, which can be triggered by lengthening of the leg after prosthetics, pressure of the resulting hematoma on the nerve formation, or, less commonly, intraoperative damage due to careless actions of the surgeon. Nerve restoration is performed through etiological treatment the optimal method of surgery or with the help of physical rehabilitation.
When an inexperienced surgeon works, there is a risk of injury to the femoral nerves.
Symptoms in the table
| Syndrome | Symptoms |
Dislocation (impaired congruence) of the prosthesis |
|
Local infectious process |
|
Thrombosis and pulmonary embolism (thromboembolism) |
|
Periprosthetic bone fracture |
|
Lesser tibial nerve neuropathy |
|
Preventive measures
Complications after hip replacement are much easier to prevent than to then undergo labor-intensive and lengthy treatment to get rid of them. Unsatisfactory development of the situation can nullify all the efforts of the surgeon. Therapy does not always give a positive effect and the expected result, therefore leading clinics provide a comprehensive perioperative program for the prevention of all existing consequences.
Infections are treated with antibiotics, which in itself is quite harmful to the body.
At the preoperative stage, diagnostics are performed for infections in the body, diseases internal organs, allergies, etc. If inflammatory and infectious processes are detected, chronic diseases in the stage of decompensation, operational measures will not begin until the identified foci of infections are cured, venous-vascular problems are reduced to an acceptable level, and other ailments do not lead to the condition stable remission.
Currently, almost all implants are made from hypoallergenic materials.
If there is a predisposition to allergic reactions, this fact is examined and taken into account, since the choice of medications, endoprosthesis materials and type of anesthesia depends on it. The entire surgical process and further rehabilitation are based on assessing the health status of internal organs and systems, age criteria and weight. To minimize the risks of complications after hip joint replacement, prophylaxis is carried out before and during the procedure, after surgery, including the long-term period. Comprehensive preventative approach:
- drug elimination of the infectious source, full compensation of chronic ailments;
- prescribing certain doses of low molecular weight heparins 12 hours in advance to prevent thrombotic events; antithrombotic therapy continues for some time after surgery;
- the use of broad-spectrum antibiotics active against a wide group of pathogens a couple of hours before the upcoming hip replacement and for several days;
- technically impeccable surgical intervention, with minimal trauma, avoiding significant blood loss and the appearance of hematomas;
- selection of an ideal prosthetic structure that completely coincides with the anatomical parameters of the real bone connection, including its correct fixation at the correct orientation angle, which in the future guarantees the stability of the implant, its integrity and excellent functionality;
- early activation of the patient in order to prevent stagnant processes in the leg, muscle atrophy and contractures, inclusion of exercise therapy and physical therapy procedures (electromyostimulation, magnetic therapy, etc.) from the first day, breathing exercises, as well as high-quality care for the surgical wound;
- informing the patient about all possible complications, permitted and unacceptable types of physical activity, precautions and the need to regularly perform physical therapy exercises.
Patient communication plays a huge role in successful treatment. medical personnel. This is what is called service, because when the patient is fully instructed, he better perceives the processes occurring in his body.
The patient must realize that the outcome of the operation and the success of the recovery depend not only on the degree of professionalism of the doctors, but also on himself. Avoid after hip replacement unwanted complications real, but only with impeccable adherence to the recommendations of specialists.
Medicine develops with the times, and its discoveries have allowed a person to restore the activity of the lower extremities by replacing a damaged joint with a prosthesis. This operation can relieve pain and discomfort, restore normal leg mobility and help prevent disability. But it happens that various complications arise that require hip replacement. Anomalies can occur due to the fact that the prosthesis did not take root, the doctor made a mistake, an infection occurred, or restoration procedures were carried out incorrectly.
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Pain syndromes
When replacing a joint, pain will inevitably occur, because this is a standard post-operative syndrome. But only if the patient has unbearable pain and it lasts more than two weeks after surgical intervention, then this is no longer normal! In such a situation, you should go to the hospital and see your doctor.
Pain may also be accompanied by accompanying symptoms. This is an increase in temperature, the occurrence of bleeding, suppuration and swelling. These signs also indicate the development of pathological processes in the body.
There are a certain number of complications that can develop after endoprosthetics and cause similar symptoms. These include:
- implant rejection;
- penetration of infection into the wound during surgery;
- the endoprosthesis has moved;
- periprosthetic fracture;
- dislocations or subluxations of the prosthesis;
- thrombosis of deep veins;
- change in leg length;
- neuropathy;
- blood loss
Groin pain
This is a rare complication. Pain in the groin occurs from the side of the surgical intervention. This symptom is caused by a negative reaction of the body to the endoprosthesis, an allergy to the material. Pain often occurs if the artificial joint is located near the anterior acetabulum.
Specific physical exercises relieve pain and help you get used to the implant. When this method turns out to be ineffective, revision endoprosthetics is performed.
In the lower back
Occurs in the lumbar region pain syndrome if the patient is sick with osteochondrosis. More specifically, the lower back begins to hurt when this disease worsens. Exacerbation is provoked by the alignment of the limbs, which was carried out after surgery.
Those who give to the knee
There may be pain in the limbs that radiates to the knee. It is especially felt when turning your legs or placing heavy loads on them. When your leg hurts after endoprosthetics, the cause is easy to determine. Soreness - a clear sign instability of the femoral component of the prosthesis.
Instability develops due to micromovements between the prosthesis and the bone. This causes the prosthesis to become loose. Various elements of the hip may become loose, such as the stem (femoral component) or the calyx (acetabular component).
Lameness and swelling
Lameness often occurs after an arthroplasty procedure. The following cases provoke its development:
- Patients who have had a fracture of the femoral neck or leg are quite susceptible to such a complication as shortening of one leg. This anomaly is a prerequisite for lameness.
- Prolonged stay without movement causes atrophy of the muscles of the limb and is the cause of lameness.
In the postoperative period, the lower limbs remain at rest for a long time, and complications such as swelling of the legs are observed. Namely, in the extremities, blood circulation and metabolism are disrupted, which causes swelling and pain. They get rid of this symptom by taking diuretics and keeping the legs slightly elevated. Also using compresses to relieve swelling and performing simple exercises.
Uneven leg lengths
The symmetry or length of the legs is disturbed after hip replacement - this is quite a rare event. The cause of this anomaly may be injury to the femoral neck. If the technique of bone restoration is violated, there is a possibility of a change in the length of the affected leg.
This complication can be overcome with the help of an operation during which bone tissue is built up in order to equalize the length of the legs. Patients and doctors extremely rarely resort to this option. Most often, the problem is solved by using specific insoles, linings in shoes, or wearing unusual shoes with different heights of soles and heels. But such shoes are made to order.
Neuropathy
Neuropathic syndrome is a lesion of the peroneal nerve, which is part of the structure of the greater sciatic nerve. This pathology occurs and is provoked by the lengthening of the leg after the prosthetic procedure and the pressure of the resulting hematoma on the nerve root. Rarely is the cause of intraoperative damage due to careless actions of the surgeon. The nerve is restored by performing etiological therapy, optimal surgical techniques or physical rehabilitation.
Endoprosthetic infection
A purulent formation at the site where a joint replacement was performed is considered very dangerous complication. It is usually difficult to treat. Therapy requires large material costs. And this pathology is usually cured by repeated surgery.
Symptoms of this pathology can manifest themselves like this:
- the place where the surgical scar is located turns red and swells;
- the suture slowly heals, and its edges diverge and form a fistula;
- serous or purulent fluid is released from the wound;
- the postoperative wound smells unpleasant;
- the patient complains of pain in the leg, which can be very powerful, so much so that it can provoke painful shock and immobilization;
- the prosthesis itself becomes unstable.
This infection progresses very quickly. Untimely or inadequate therapy provokes reclassification of the pathology into chronic osteomyelitis. Treatment takes a long time. The implant can be replaced only when the patient has completely overcome the infection.
As a preventive measure for this complication, immediately after the implant has been replaced, the patient is prescribed a course of antibiotic therapy. They are drunk for two or three days.
Temperature increase
The endoprosthetics operation often provokes the occurrence of hyperthermia, or an increase in the overall thermal state of the body. Patients also often complain of increased local temperature in the area where the implant was implanted. There are situations when the temperature rises due to stress from the operation, and there are situations when it is caused by inflammation or infection.
Usually, antipyretics are taken to reduce it. When it is provoked by some pathology, eliminating the temperature is not enough, you need to overcome the cause.
Implant dislocation and subluxation
This excess may occur in the first year after prosthetics were performed. This condition is the leader in its prevalence. The pathology is characterized by displacement of the femoral element in relation to the acetabular element. Because of this, there is a separation between the prosthesis cup and the head.
Provocative factors are abnormal loads, injuries, errors in the selected model and installation of the endoprosthesis, and the use of a posterior surgical approach. The dislocation is usually reduced without surgery or by open reduction. If you contact a specialist in a timely manner, the head of the implant is adjusted in a closed way, the patient is under anesthesia at this moment. In advanced situations, the doctor prescribes a repeat operation to reinstall the prosthesis.
Periprosthetic fracture
People with a femoral neck fracture, excess weight, dysplasia, neuromuscular abnormalities, increased joint mobility and Ehlers syndrome can be considered at risk. And also in older people who are over sixty years of age, there is a high probability of developing a periprosthetic fracture. This anomaly, in which the integrity of the femur near the area of fixation of the leg with a stable or unstable prosthesis is disrupted, occurs intraoperatively. It can occur at absolutely any time after the surgical session (after a couple of days, months or years).
A fracture is often caused by decreased bone density. But it can also be triggered by incompetently performed development of the bone canal before installing an artificial joint. Or the cause may be an incorrectly chosen fixation method. Treatment depends on the type and severity of the injury. Usually one of the methods of osteosynthesis is used. The leg, if necessary, is replaced with one that is more suitable in configuration.
Deep vein thrombosis
Reduced physical activity in the period after surgery provokes blood stagnation, which results in thrombosis. And then it all depends on how big the blood clot is and where the blood flow takes it. Because of this, the following consequences can occur: pulmonary embolism, gangrene of the legs, heart attack and others.
This pathology should be prevented as early as possible. Already on the second day after joint implantation, anticoagulants are prescribed.
Blood loss
During surgery to replace the pelvic joint or some time after the procedure, there is a possibility of bleeding. The cause could be a doctor’s mistake, or any careless movement or abuse of blood thinning medications. Postoperatively, anticoagulants are prescribed to prevent thrombosis.
Sometimes this very precaution can backfire. It can turn preventive measures from one complication into another complication. To restore blood supplies, the patient requires a blood transfusion.
Displacement of the endoprosthesis
The pelvic joint implant may become displaced due to impaired mobility and postoperative recommendations. It is strictly forbidden to cross your limbs or raise them high. The displacement causes severe pain and discomfort.
Implant failure
The body rejects the installed prosthesis very rarely, because before the operation the sensitivity of the body's cells to the material of which the prosthesis is made is always tested. In situations in which the material is not suitable, it is replaced and retested. The procedure is carried out until a suitable material is selected that will match the tissues.
Video “Complications after endoprosthetics”
In this video you will learn about complications after hip replacement surgery.
- Risk factors
- Possible complications
- Pain after endoprosthetics
Hip replacement is an operation to replace the affected joint with an endoprosthesis. As with any other surgical procedure, complications may occur. This is explained by the individual characteristics of the body, health status and complexity of the operation.
Pain after endoprosthetics is inevitable. This is explained by the peculiarities of the operation.
Risk factors
- Advanced age of the patient.
- Concomitant systemic diseases.
- Postponed surgeries or infectious diseases history of hip joint.
- Availability acute injury proximal femur.
Possible complications
Rejection of a foreign body (implant) by the body
This consequence occurs extremely rarely, because usually before surgery, after selecting a prosthesis, tests are carried out to determine individual sensitivity to the material. And if there is intolerance to the substance, then another prosthesis is selected.
The same applies to allergic reactions to anesthesia or the material from which the prosthesis is made.
Infection in the wound during surgery
This is a serious condition that can be treated long time with the help of antibiotics. Infection can occur on the wound surface or deep in the wound (in soft tissues, at the site of the prosthesis). The infection is accompanied by symptoms such as swelling, redness and pain. If treatment is not started in time, you will need to replace the prosthesis with a new one.
Bleeding
It can begin both during the operation and after it. The main reason is medical error. If help is not provided in time, then the patient, at best, may need a blood transfusion, at worst, hemolytic shock and death will occur.
Prosthesis displacement
Changing leg length
If the prosthesis is not installed correctly, the muscles near the joint may weaken. They need to be strengthened, and physical exercise is the best way to do this.
The risk of complications decreases with proper rehabilitation after endoprosthesis surgery Deep vein thrombosis
After a decrease in physical activity in the postoperative period, blood stagnation may occur, and as a result, blood clots may occur. And then everything depends on the size of the blood clot and where the blood flow carries it. Depending on this, the following consequences may arise: pulmonary thromboembolism, gangrene of the lower extremities, heart attack, etc. To prevent this complication, you need to begin vigorous activity at the appointed time, and anticoagulants are prescribed on the second day after the operation.
The following complications may also arise over time:
- Weakening of joints and disruption of their functioning.
- Destruction of the prosthesis (partial or complete).
- Dislocation of the head of the endoprosthesis.
- Lameness.
These complications after hip replacement occur less frequently and over time. To eliminate them, you need surgery (replacement of the endoprosthesis).
Pain after endoprosthetics
The only complication that will accompany endoprosthetics under any conditions is pain.
To get to the joint, it is necessary to cut the fascia and muscles of the thigh. After stitching, they will grow together in about 3-4 weeks. When performing movements, pain will occur. And since movements are mandatory so that the muscles grow faster and correctly, pain will be felt almost throughout the entire rehabilitation period.
Endoprosthetics is a serious operation. After it, certain complications are possible, but with timely diagnosis and treatment, everything can be eliminated without unnecessary harm to health.
MoyaSpina.ru
Pain after hip replacement: causes and treatment
Hip arthroplasty is the replacement of a damaged articulation element with an artificial implant.
This operation is prescribed according to various reasons, these may be complex diseases of the hip joint or injuries.
After endoprosthetics, the patient must follow certain recommendations.
Indications for prosthetics
Most often, endoprosthesis replacement surgery is prescribed in the following situations:
- Femoral neck injuries (usually fractures).
- Severe, advanced stages of rheumatoid arthritis.
- Availability aseptic necrosis heads (avascular necrosis).
- Development of hip dysplasia.
- Severe stages coxarthrosis.
The need for an implant may arise as a result of post-traumatic complications, for example, arthrosis. The patient’s life after endoprosthetics changes, as a number of recommendations appear that must be strictly followed.
There are some restrictions; the patient must perform a set of special physical therapy. At first, the patient is forced to use crutches.
The duration of the postoperative period and complete recovery depend entirely on general condition the patient, his age and numerous other factors. In order to avoid possible complications from hip replacement, the patient must be disciplined in following the recommendations of the attending physician.
The complex of therapeutic exercises, which is necessary to restore the hip joint, must be performed under the supervision of a medically qualified instructor. Living in a new mode will significantly bring the moment of complete recovery closer, thanks to which the patient will be able to start walking much faster without the help of crutches. It can also be noted that rehabilitation after hip replacement can continue at home.
After endoprosthetics, pain is usually pronounced. It is strictly forbidden to take any measures on your own, otherwise you may experience serious complications.
The main indications for endoprosthetics surgery are the symptoms that accompany the disease and the results of clinical and radiological studies. The symptoms indicated by the patient are the most significant factor that is an indication for surgery.
In some situations, despite the fact that coxarthrosis is in the last stage of its development (this is clearly demonstrated by x-ray examination), a person is not bothered by pain and other symptoms of the disease. This pathology does not require surgical intervention.
Modern hip endoprosthesis - its features
Modern orthopedics has made significant progress in its development. A feature of today's endoprosthesis is its complex technical structure. The prosthesis, which is fixed in the bone without cement, consists of the following elements:
- leg;
- cup;
- head;
- insert.
The endoprosthesis, which is fixed with cement, differs from the previous one in the integrity of the acetabular element.
Each component of the implant has its own parameters, so the doctor must determine the size that is ideal for a particular patient.
Endoprostheses also differ from each other in the method of fixation. Exists:
- Fixation is cement.
- Fixation is cementless.
- Combined fixation (hybrid of the first two).
Since reviews about different types of endoprosthesis are mixed, before hip replacement surgery it is necessary to collect as much information as possible about the implant.
The endoprosthesis can be unipolar or total. The use of one or another artificial joint depends on the number of elements requiring replacement. The interaction in the endoprosthesis is called a “friction pair”.
How long an artificial hip implant can last depends entirely on the quality of the material from which the endoprosthesis is made.
How is endoprosthetics surgery performed?
The hip replacement process is performed by two teams - anesthesiology and operating room. The operating room team is led by a highly qualified practicing surgeon. In the photo you can see where the doctor makes an incision to remove and replace the joint.
The average duration of hip replacement surgery is 1.5-2 hours. The patient is under anesthesia at this time or spinal anesthesia so he doesn't feel pain. To exclude infectious complications, intravenous antibiotics are required.
After endoprosthetics, the patient remains in the intensive care unit for some time, under constant medical supervision. Over the next seven days, the patient continues to be administered drugs that prevent blood clotting and antibiotics.
In order to maintain a certain distance between the legs, a pillow is placed between them. The patient's legs should be in an abducted position.
Body temperature after hip replacement is often unstable. The patient feels pain for some time, so he is given anesthetics.
It is impossible to predict in advance how long the recovery period after endoprosthetics will take. In order for the rehabilitation process to go much faster, the patient must be disciplined and must follow all the recommendations of the attending physician.
Recommendations that must be followed for the rest of your life The patient should start moving the very next day. And this is done without getting out of bed. The patient can move and perform therapeutic exercises right on the bed.
To fully restore mobility in the hip joint, it is necessary to constantly work on its development. In addition to a course of physical therapy, the patient is shown breathing exercises.
Most often, the patient can walk already on the third day of rehabilitation, but he must use crutches. After a few days, doctors will remove the stitches. After the operation to implant an artificial implant, the sutures are removed on the 10th, 15th day. It all depends on how quickly the patient recovers.
Many patients ask themselves: upon arrival home, how to live next? After all, in the hospital they were under the constant supervision of doctors and staff, and the entire recovery process was under control.
Indeed, life with an endoprosthesis is somewhat different from the life that preceded endoprosthesis. It has already been said above that you need to constantly work on an artificial hip joint.
The patient should move as much as possible, but avoid fatigue and hip pain. Therapeutic exercises play a huge role in the recovery process, but a set of exercises should be compiled by a doctor who keeps the patient’s medical history.
Returning home, the patient must work hard on the new joint, otherwise the recovery period may take a long time.
If the patient does not want serious complications to arise after the operation and pain to recur after returning home, he must follow a number of recommendations.
- The artificial joint should not be allowed to bend completely.
- In the “sitting” position, the knees should not be in the same plane as the hips; they should be lower. Therefore, it is recommended to place a pillow on the chair.
- Whatever position the patient is in, he should not cross his legs.
- When getting up from a chair, your back should remain straight and you should not lean forward.
- You need to use crutches until your doctor stops them.
- Walking in the first days after endoprosthetics can only be done with the help of medical staff.
- Shoes should be as comfortable as possible, so heels are contraindicated.
- When visiting another doctor, he must be informed that the hip joint is artificial.
Hip replacement requires work not only on the joint itself, the patient must always take care of his overall health. If pain occurs in the area of the hip into which the artificial implant was implanted, accompanied by an increase in body temperature, you should immediately consult your doctor.
It is likely that many of these recommendations will eventually be abandoned. This will depend on how long it takes the patient to fully recover. Usually seven to eight months are enough for rehabilitation.
The patient should be informed that an artificial hip implant, like any mechanism, has its own service life. Therefore, over time, the endoprosthesis wears out. On average, its validity period lasts 10-15 years and depends on certain conditions and features.
If the endoprosthesis quickly fails, most likely it was not used correctly. A patient with an artificial hip prosthesis is contraindicated in any active species sports
When doing physical therapy at home, the patient should be aware that ignoring the doctor’s recommendations can cause serious complications. Exercise therapy exercises should not be difficult or cause pain. Large loads should not be placed on the artificial joint.
sustav.info
Pain and complications after hip replacement
Hip replacement surgery allows a person to return to full life and say goodbye to those arthritic symptoms that prevented you from experiencing the joys of life for many years in a row. Studies show that complications after hip replacement develop in 1% of young people and 2.5% of older patients. All this is true, but you shouldn’t relax! Despite the minuscule probability of developing negative consequences, an unpleasant situation can affect anyone, and especially those who did not strictly follow the rehabilitation program.
Image of the position of the endoprosthesis in the human body.
As a rule, complications after hip replacement are caused by improper postoperative care and non-compliance with physical activity after discharge from the hospital. The second reason for an unfavorable prognosis, which happens much less frequently, is the surgeon’s mistakes. Thus, the overall success of the treatment is influenced by the status of the medical institution and the qualifications of the medical staff, where, in fact, the patient was operated on, observed and received high-tech medical care - surgical and rehabilitation treatment.
The pain comes in different forms, but there is the right kind - after moderate physical exertion. And there is an acute one, talking about problems that need to be diagnosed urgently.
Complication statistics as a percentage
The operation to install a hip joint prosthesis today is a tremendous success, since in modern orthopedics is the only effective method that “puts” the patient on his feet, relieves debilitating pain and limited ability to work, and allows him to return to healthy physical activity. Unpleasant pathological situations associated with implantation occur infrequently. However, in isolated cases they were recorded, about which the patient should be informed. According to ongoing randomized controlled trials, the following data have been obtained about the most common problems:
- dislocation of the head of the prosthesis develops in approximately 1.9% of cases;
- septic pathogenesis– 1.37%;
- thromboembolism – in 0.3%;
- periprosthetic fracture occurs in 0.2% of cases.
Often they develop not through the fault of the surgeon, but the patient himself, who did not deign to continue rehabilitation at a specialized medical institution or did not adhere to a special physical regimen after the end of recovery. Deterioration of the condition often occurs at home, when there is no close monitoring from doctors that was in the clinic.
If you have had surgery, enough time has passed, but your leg cannot repeat the range of motion of the healthy limb, then this is the result of a lack of rehabilitation.
Forecasting possible complications, drug and non-drug control, mandatory early prevention of concomitant diseases, the use of adequate tactics of surgical intervention and a competent rehabilitation program can significantly minimize the likelihood of postoperative consequences.
Attention! In exceptional situations, even despite all precautions and safety measures taken, undesirable postoperative effects may occur. Not a single orthopedic specialist, even with rich and impeccable work experience, can 100% predict how a particular body will behave after such complex manipulations on the musculoskeletal system, and give the patient a complete guarantee that everything will go smoothly and without incidents.
Differentiation of pain: normal or not
Pain after hip replacement will be observed in the early period, because the body has undergone a serious orthopedic operation. The painful syndrome during the first 2-3 weeks is a natural response of the body to a recent surgical injury, which is not considered any deviation.
Until the surgical injury heals, the muscle structures return to normal, and oh, how they suffered from the previous illness, until the articular bones together with the endoprosthesis become a single kinematic link, the person will experience discomfort for some time. Therefore, at the initial stage of recovery, a good pain reliever is prescribed, which helps to cope with early painful symptoms more easily and to better concentrate on treatment and rehabilitation activities.
Well-healing suture after surgery. It is smooth, pale and has no discharge.
However, you need to understand that with all complications after hip replacement, the symptom of pain manifested at the site of the implanted prosthesis can signal an already existing serious danger. Therefore, pain sensations must be professionally differentiated: which of them is normal and which is a real threat. And this, as is easy to understand, is within the competence of only a qualified specialist. The patient’s task is to immediately notify the orthopedic doctor if any signs of discomfort occur.
Important! If pain increases after hip replacement or there is no positive dynamics in reducing the pain factor at any stage, this should be reported to a specialist immediately! Since there is a high probability that they indicate the emergence or already progression of dangerous complications. The doctor will identify what is associated with pain after hip replacement, determine the exact cause of postoperative pathogenesis and take action. emergency measures for its liquidation.
Main risk factors
Hip replacement, like any surgical intervention, does not exclude complications, and quite serious ones. Especially if mistakes were made during the intra- and/or postoperative period. Even small errors during surgery or during rehabilitation increase the likelihood of unsatisfactory hip arthroplasty. In addition, there are also so-called risk factors that increase the body’s susceptibility to postoperative consequences and often become their cause, these include:
- advanced age of a person;
- severe concomitant disease, for example, diabetes mellitus, arthritic disease of rheumatoid etiology, psoriasis, lupus erythematosus and other systemic ailments;
- any previous surgical intervention on the “native” joint aimed at treating dysplasia, femoral fractures, coxarthrosis deformities (osteosynthesis, osteotomy, etc.);
- re-endoprosthetics, that is, repeated replacement of the hip joint;
- local inflammation and purulent foci in the patient's history.
Let us note that after hip joint replacement, elderly people, and especially those over 60, are more susceptible to complications. This is explained simply: in elderly patients, as a rule, in addition to the underlying disease, there is a “bouquet” of other accompanying pathologies, which can complicate the course of rehabilitation, for example, reduce resistance to infection. In addition, in people of advanced years, due to physiological changes in the body caused by age, there is a reduced potential for reparative and restorative functions, weakness of the muscular-ligamentous system, osteoporotic signs, and a certain degree of lymphovenous insufficiency of the lower extremities.
It is more difficult for older people to recover, but this can be done successfully.
Replacement of a non-viable hip joint and complications with the above problems, as shown by clinical experience, have a direct relationship. But this does not mean that hip replacement is contraindicated for the older generation. No, in most cases it is allowed, because it is precisely these people who most often need such intervention. It’s just that the specialist must take into account the patient’s health indicators down to the smallest detail and take all necessary measures to ensure that endoprosthetics and recovery go well for him. However, such a competent approach is practiced in all highly professional clinics, and for absolutely every patient, regardless of age.
Concept and methods of treating consequences
Complications after hip replacement, the symptoms for better understanding will be presented below in the table, must be detected in a timely manner. A quick visit to a doctor at the first suspicious signs will help to avoid the progression of adverse events, and in some situations, to preserve the implant without resorting to revision surgery. It is important to understand that the more advanced the clinical picture becomes, the more difficult it will be to respond to therapeutic correction.
You can’t talk about symptoms until it becomes clear what complications after hip replacement generally are. So, let’s explain the concepts of the main types of pathogenesis, the causative factor of their occurrence and ways to eliminate them.
Dislocations and subluxations of the endoprosthesis
As a rule, negative excess occurs in the first year after prosthetics. This is the most common pathological condition in which the femoral component is displaced in relation to the acetabular element, resulting in separation of the head and cup of the endoprosthesis. Provocative factors are excessive loads, errors in the selection of the model and installation of the implant (defects in the placement angle), the use of a posterior surgical approach, and trauma.
Dislocation of the femoral component on x-ray.
It should be noted that the risk group includes people with hip fractures, dysplasia, neuromuscular pathologies, obesity, joint hypermobility, Ehlers syndrome, and patients over 60 years of age. Individuals who have undergone surgery on a natural hip joint in the past are also particularly vulnerable to dislocation. The dislocation requires non-surgical reduction or open repair. If treated in a timely manner, the endoprosthetic head can be adjusted in the vast majority of cases using a closed method under anesthesia. If the problem continues, the doctor may prescribe a repeat operation to reinstall the endoprosthesis.
Paraprosthetic infection
The second most common unfavorable phenomenon, characterized by the activation of severe purulent-inflammatory processes of an infectious nature in the area of the installed implant. Infectious antigens are introduced intraoperatively through insufficiently sterile surgical instruments (rarely) or after intervention they move through the bloodstream from any problematic organ that has a pathogenic microbial environment (often). Poor treatment of the wound area or poor healing (in diabetes) also contributes to the development and proliferation of bacteria.
Discharge from a surgical wound is a bad sign.
A purulent focus has a detrimental effect on the strength of fixation of the endoprosthesis, causing its loosening and instability. Pyogenic microflora is difficult to treat and, as a rule, requires removal of the implant and re-installation after a long time. The main principle of treatment is a test to determine the type of infection, long and expensive antibiotic therapy, and abundant lavage of the wound with antiseptic solutions.
The arrows indicate areas of infectious inflammation, this is exactly what they look like on an x-ray.
Thromboembolism (PE)
PE is a critical blockage of the branches or main trunk of the pulmonary artery by a detached thrombus, which formed after implantation in the deep veins of the lower limb due to low blood circulation resulting from limited mobility of the leg. The culprits of thrombosis are the lack of early rehabilitation and necessary drug treatment, prolonged stay in an immobilized state.
This complication is dealt with quite successfully at this stage of medical development.
Blocking the lumen of the lungs is dangerously fatal, so the patient is immediately hospitalized in the intensive care unit, where, given the severity of the thrombotic syndrome, they provide qualified assistance: administration of thrombolytics and drugs that reduce blood clotting, NMS and mechanical ventilation, embolectomy, etc.
Periprosthetic fracture
This is a violation of the integrity of the femur in the area of fixation of the leg with an unstable and stable prosthesis, occurring intraoperatively or at any time after the surgical session (several days, months or years later). Fractures more often occur due to reduced bone density, but can be a consequence of incompetent development of the bone canal before installing an artificial joint, or an incorrectly chosen method of fixation. Therapy, depending on the type and severity of the damage, consists of using one of the methods of osteosynthesis. The leg, if necessary, is replaced with a corresponding part that is more suitable in configuration.
Implant failure occurs very rarely.
Neuropathy
Neuropathic syndrome is a lesion of the peroneal nerve, which is part of the structure of the greater sciatic nerve, which can be caused by lengthening of the leg after prosthetics, pressure of the resulting hematoma on the nerve formation, or, less commonly, intraoperative damage due to careless actions of the surgeon. Nerve restoration is performed through etiological treatment with the optimal surgical method or through physical rehabilitation.
When an inexperienced surgeon works, there is a risk of injury to the femoral nerves, which entails constant pain after operation.
Symptoms in the table
| Syndrome | Symptoms |
| Dislocation (impaired congruence) of the prosthesis |
|
| Local infectious process |
|
| Thrombosis and pulmonary embolism (thromboembolism) |
|
| Periprosthetic bone fracture |
|
| Lesser tibial nerve neuropathy |
|
Preventive measures
Complications after hip replacement are much easier to prevent than to then undergo labor-intensive and lengthy treatment to get rid of them. Unsatisfactory development of the situation can simply reduce all the efforts of the surgeon to zero. In addition, therapy for a pathological condition does not always give a positive effect and the expected result, therefore leading clinics provide a comprehensive perioperative program for the prevention of all existing consequences. It begins to operate from the first days of the patient’s admission to the medical center.
Infections are treated with antibiotics, which in itself is quite harmful to the body.
At the preoperative stage, a comprehensive diagnosis is carried out for the presence of infections in the body, diseases of internal organs, allergies, etc. If inflammatory and infectious processes, chronic diseases in the decompensation stage are detected, surgical measures will not begin until the identified foci of infections are cured, venous -vascular problems will not be reduced to an acceptable level, and other ailments will not lead to a state of stable remission.
Currently, almost all implants are made from hypoallergenic materials.
If there is a predisposition to allergic reactions, this fact is qualitatively examined and taken into account, since the choice of medications, endoprosthesis materials and type of anesthesia depends on it. Moreover, on assessing the health status of internal organs and systems, age criteria, weight and other individual characteristics the entire surgical process and further rehabilitation are planned. To minimize the risks of complications after hip joint replacement, prophylaxis is carried out before and during the procedure, after surgery, including the long-term period. An integrated preventive approach is based on the implementation of such measures as:
- drug elimination of the infectious source, full compensation of chronic ailments;
- prescribing certain doses of low molecular weight heparins 12 hours in advance to prevent thrombotic events; antithrombotic therapy continues for some time after surgery;
- the use of broad-spectrum antibiotics active against a wide group of pathogens a couple of hours before the upcoming hip replacement and for several days;
- technically impeccable surgical intervention, with minimal trauma, avoiding significant blood loss and the appearance of hematomas;
- selection of an ideal prosthetic structure that completely coincides with the anatomical parameters of the real bone connection, including its correct fixation at the correct orientation angle and in the most advantageous way, which in the future guarantees the stability of the implant, its integrity and excellent functionality;
- early activation of the patient in order to prevent stagnant processes in the leg, muscle atrophy and contractures, inclusion of exercise therapy and physiotherapy procedures (electromyostimulation, magnetic therapy, etc.), breathing exercises from the first day, as well as high-quality care surgical wound;
- informing the patient about all possible complications, permitted and unacceptable types of physical activity, precautions and the need to regularly perform physical therapy exercises.
Communication between the patient and the doctor or other medical personnel plays a huge role in successful treatment. This is what is called service, because when the patient is fully instructed, he better perceives the processes occurring in his body.
The patient must realize that the outcome of the operation and the success of the recovery depend not only on the degree of professionalism of the doctors, but also on himself. After hip replacement surgery, it is possible to avoid unwanted complications, but only if you strictly follow the recommendations of specialists.
Advice! To protect yourself as much as possible from the development of negative processes, in mandatory it is necessary to undergo a full-fledged rehabilitation course in a good medical institution that directly specializes in the recovery of people after joint replacement.
msk-artusmed.ru
How to get rid of pain after endoprosthetics
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Hip replacement is a surgical procedure aimed at replacing the affected joint with a special prosthesis. The operation is considered quite complex, and various complications can often arise after endoprosthetics. They can be characterized by pain in the hip joint.
Pain almost always occurs after surgery. This is explained by the peculiarities of endoprosthetics.
Possible complications causing pain
Complications that can occur after endoprosthetics cause severe pain. These include:
- Rejection of the implant by the body;
- Penetration of infection into the wound during surgery;
- Implant displacement;
- Deep vein thrombosis;
- Bleeding;
- Changing leg length.
Rejection of an installed prosthesis rarely occurs, since testing of individual tissue sensitivity to the prosthesis material is usually performed before surgery. In cases where the material is not suitable. It is being replaced and retested. The procedure is carried out until the material corresponding to the cells of the body is selected.
When an infection enters the wound, not only pain is observed, but also noticeable swelling and redness of the skin at the site of the suture. To eliminate this complication you will need to take antibiotics. The source of infection may be on the surface of the wound or inside it, for example, where a joint prosthesis is installed.
Hip implant displacement can occur due to irregularities in activity patterns and postoperative guidelines. For example, it is strictly forbidden to cross your legs or lift them high. Displacement can cause severe pain and discomfort.
Blood stagnation due to decreased physical activity can cause blood stagnation, which develops into deep vein thrombosis. The consequences are not only severe pain, but also the occurrence of such serious diseases as heart attack and gangrene of the lower extremities.
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Doctors' opinion...
Bleeding can occur not only during the operation, but also after it. In this case, pain occurs quite rarely.
If the prosthesis is installed incorrectly, the muscles located in close proximity to the joint weaken. This may cause a sensation of change in leg length and mild pain.
Pain after endoprosthetics, which is considered normal
Pain is the only complication after endoprosthetics that accompanies the postoperative period in any case. This is due to the numerous muscle incisions that are made to access the joint.
When the tissues grow together, pain occurs in the hip joint, which can last about 3-4 weeks. If you follow the recommendations after endoprosthetics and regularly perform the necessary movements, you can achieve rapid pain relief.
What to do to reduce pain and eliminate it completely?
In order to try to reduce the duration of pain and completely get rid of them, first of all, you need to establish their cause. To do this, you should contact a specialist who will prescribe the necessary examination of the replaced hip joint in order to diagnose the causes of the pain.
If the pain is provoked by complications of endoprosthetics, then their nature of occurrence is clarified and prescribed competent treatment. In cases where pain is caused by the postoperative period, experts give recommendations for quickly eliminating it:
- Follow all recommendations of a specialist on physical activity and rest after surgery;
- Perform a complex of therapeutic exercises;
- Do not make sudden movements, do not raise your legs high or cross them;
- Do not allow blood to stagnate in the tissues in the hip joint area;
- Use crutches at first;
- Whenever discomfort and increasing pain in the hip joint, immediately contact a specialist.
Conclusion
In conclusion, we can say that pain after endoprosthetics can have a different nature of origin. It is very important to accurately establish their nature and causes. In cases of postoperative pain, which is a normal manifestation of the body, you should follow all the specialist’s recommendations in order to eliminate them as soon as possible.
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Judging by the fact that you are now reading these lines, victory in the fight against joint pain is not yet on your side... Constant or periodic pain, crunching and noticeable pain during movement, discomfort, irritability... All these symptoms are familiar to you firsthand.
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systavi.ru
Complications after hip replacement
New medical discoveries have made it possible to restore the activity of the lower extremities through hip replacement. This procedure helps to get rid of debilitating pain and discomfort, restores the functioning of the legs and helps to avoid disability. But sometimes various kinds of complications arise after hip replacement. Pathologies can develop due to medical error, infection, failure of the prosthesis to take root, or improper restoration procedures.
Common complications after hip replacement
The operation to replace patients with an artificial hip joint has been carried out very successfully for more than thirty years. Such intervention is especially in demand after hip (neck) fractures, damage to the musculoskeletal system, when the cup wears out due to age-related changes. Regardless of the cost of hip replacement surgery, complications are uncommon. But if the treatment of problems is not started in a timely manner, the patient faces disability, immobility of the lower extremities, and in the event of pulmonary embolism (thromboembolism), death.
Conventionally, all the causes of the consequences and difficulties of the postoperative period after such prosthetics are divided into several groups:
- caused by the body not accepting the implant;
- negative reaction to a foreign body;
- allergy to the prosthesis material or anesthesia;
- infection during surgery.
Complications after hip replacement negatively affect not only the hip area, but also affect the general physical, psychological state, physical activity and walking ability. To regain your previous health, you need to undergo a series of rehabilitation measures, which are prescribed based on the developed pathologies and problems. For quick and effective recovery it is necessary to establish the reasons for the development of complications and limitations after hip replacement.
General complications
The development of the medical industry does not stand still; hundreds of discoveries occur every year that can change lives and give a chance to many patients. But complications after surgery are common. During hip replacement, in addition to specific difficulties, general pathologies:
- Allergy to medications used before or during surgery. For example, for anesthesia.
- Deterioration in the functioning of the heart muscle (surgery is always a load on the heart), which can provoke attacks and diseases of cardio-vascular system.
- Impaired motor activity, which is not caused by the body’s perception of a foreign body or an allergy to the implant material (for example, ceramics).
Infection at the surgical site
Often during hip replacement surgery, a complication such as infection of the soft tissue at the incision site or the implant itself occurs. Why is infection dangerous?
- Severe pain occurs in the area of surgery and placement of the endoprosthesis.
- At the site of the incision, suppuration, swelling and discoloration of the skin are observed.
- Septic instability of the new joint can become critical, resulting in impaired motor function of the lower extremities.
- The formation of a fistula with purulent discharge, which is especially often observed if timely treatment is not started.
To prevent complications after hip replacement from nullifying the efforts during surgery, treatment should be selected and started in a timely manner. Taking the following will help get rid of the infection: special antibiotics and the use of temporary spacers (implants). The treatment process will be long and very difficult, but the achieved result will please the patient.
Pulmonary embolism
The most dangerous complication that can develop after installation of an artificial joint (endoprosthesis) is pulmonary embolism. The formation of blood clots is often caused by immobility of the leg, which leads to poor circulation in the lower extremities. This disease is often fatal, so it is necessary to preventive measures, for example, take anticoagulants, which are prescribed by the doctor for several postoperative weeks.
Blood loss
Bleeding may occur during hip replacement surgery or some time afterward. The causes are medical error, careless movement or abuse of medications that thin the blood. In the postoperative period, anticoagulants are prescribed to prevent thrombosis, but sometimes such caution can play a cruel joke, turning preventive measures into a source of trouble. The patient may need a blood transfusion to replenish supplies.
Dislocation of the prosthesis head
One of the complications after hip replacement is dislocation of the head of the prosthesis. This complexity is caused by the fact that the endoprosthesis is unable to completely replace a natural joint and its functionality is much lower. Falls, improper rehabilitation, performing difficult exercises or sudden movements can trigger a dislocation, which will lead to complications. As a result, the functioning of the musculoskeletal system and the activity of the lower limb will be disrupted.
To avoid complications after endoprosthetics, you should be extremely careful in your movements during the postoperative period: you should not turn your leg inward too much, and its bending at the hip joint should not be more than 90 degrees. Revision hip replacement will help eliminate the complication, and for complete healing it will be necessary to completely immobilize the leg for a while.
Loosening of the endoprosthesis structure
As a result of vigorous activity and leg movements, the artificial joints become loose. This negatively affects the condition of bone tissue. Loosening causes destruction of the bone where the endoprosthesis is inserted. Subsequently, such instability of the prosthetic area can lead to fracture. The only option to prevent loosening is to reduce motor activity, and to eliminate an existing problem, revision hip arthroplasty is used.
Lameness
Lameness is a common complication after hip replacement surgery. This pathology can develop as a result of some cases:
- Patients who have had a leg or hip fracture after hip replacement surgery often experience shortening of one leg, which leads to a limp when walking.
- Long-term immobilization and a state of rest of the lower limb can provoke atrophy of the leg muscles, which will cause lameness.
Surgical intervention, during which bone tissue is built up to equalize the length of the legs, will help get rid of the complication. Patients and doctors resort to this option extremely rarely. As a rule, the problem is solved by using special insoles, linings in shoes or wearing special shoes with different sole heights and heels, which are sewn to order.
Groin pain
A rare complication after hip replacement is pain in the groin area from the surgical intervention. The pain caused may be a negative reaction of the body to the prosthesis, or an allergy to the material. Pain often occurs if the implant is located in the anterior part of the acetabulum. Performing special physical exercises will help you get rid of pain and get used to the new joint. If this does not bring the desired result, revision endoprosthetics will have to be performed.
Swelling of the legs
After surgery, as a result of keeping the leg at rest for a long time, a complication such as swelling of the lower extremities is often observed. Blood flow and metabolic processes are disrupted, which leads to swelling and pain. Taking diuretics, keeping your legs elevated, using compresses that relieve swelling, and regularly performing simple exercises will help get rid of this problem.
Therapeutic exercises for recovery after endoprosthetics
To get rid of complications after hip replacement and make the rehabilitation process as fast and painless as possible, you must regularly perform physical exercises prescribed by the doctor. Thanks to simple actions, the motor activity of the new artificial joint develops, and the patient regains the ability to move with his legs without the use of crutches.
A set of exercises for recovery after hip replacement is selected individually. It takes into account the following factors:
- patient's age;
- activity of the lower limb where the joint was replaced;
- the general health of the patient;
- psycho-emotional state of the patient.
When performing physical exercises and while walking, it is important to remember that patients after hip replacement surgery are strictly prohibited from:
- crossing legs;
- flexion of the lower limbs at the hip joint by more than ninety degrees;
- twisting the leg to the side.
To make rehabilitation more effective, perform a set of exercises after hip replacement surgery:
- Take a lying position on your back (a harder surface is ideal - an elastic mattress or the floor), perform a number of simple exercises one by one:
- Bending the legs at the knee joint without lifting the foot from the surface.
- Abduction of the lower extremities to the side (alternately with a leg with an artificial and natural joint).
- Bike. Raise your legs slightly up and perform movements that simulate riding a two-wheeled pedal vehicle.
- Alternately straightening and returning to a bent position with legs bent at the knees.
- Change position by turning onto your stomach. In this position, perform the following exercises:
- Flexion and extension of the knee joint.
- Raising your leg up.
- Lying on your side, lift straight lower limb up and then move it to the side. Repeat a similar exercise, turning on the other side.
- In a standing position, swing your legs forward, backward and move your lower limb to the side.
- When performing this complex, do not make sudden movements so that the cup of the joint does not jump out or become loose, causing all sorts of complications and pain.
Rehabilitation centers and costs
For rehabilitation and relief from complications after endoprosthetics, people often choose clinics abroad, giving preference to sanatoriums or hospitals, for example, in Germany and Israel. But on the territory of Russia there are also medical centers, where it is possible to undergo recovery after surgery, to cure pathologies that arose after it. There are such clinics in large cities of the country, for example, Moscow, Voronezh, St. Petersburg, where qualified doctors work who can provide assistance in rehabilitation.
The cost of rehabilitation measures after hip replacement in different sanatoriums may vary depending on many factors:
- Location of the hospital. In sanatoriums located in picturesque corners, the price per day will be much higher than in clinics located on the outskirts of the city.
- Services provided at the clinic. The longer the list of procedures, the higher the cost. Especially relevant are massage, exercise therapy, and classes on special exercise equipment (for example, an exercise bike).
- The comfort of wards or rooms directly affects the price of accommodation in rehabilitation centers.
Sanatoriums, clinics and cost of rehabilitation after hip replacement in Moscow and St. Petersburg:
Video about rehabilitation methods
A rehabilitation course in a clinic or sanatorium will help you cope with complications after hip replacement. Medical institutions with experienced and polite staff, the latest equipment and the use of modern recovery techniques are available not only in newfangled foreign health resorts, but also in Russian hospitals. Rehabilitation measures are aimed at reducing pain, improving general health, restoring joint functionality, and generating strength so that the implant can withstand certain loads.
For recovery after hip replacement, methods are used whose effectiveness has been proven by many patients:
- Specialized massotherapy, aimed at postoperative recovery and relief of pain arising after surgery.
- Electrotherapy – relieves pain and promotes rapid recovery.
- Laser therapy is a procedure that has a beneficial effect on postoperative suture.
- Magnetic therapy – promotes tissue regeneration in the area of surgical intervention.
- Drinking thermal waters, which promotes rapid restoration of joints, improves their mobility and reduces pain.
- Physiotherapy, exercises that are carried out to improve the motor activity of the leg depending on the physical, psychological and emotional state patient, and is prescribed after a thorough examination.
To obtain maximum results, it is necessary to use all methods in combination. Watch the video to learn more about the methods of dealing with the consequences after hip replacement:
Negative consequences and complications after hip arthroplasty (HJ) occur infrequently, but they are not excluded. In the postoperative period, the patient may experience inflammation with the addition of bacterial infection. Due to non-compliance with the doctor’s recommendations, dislocations and fractures of the prosthesis, blood clots and other disorders occur. If after endoprosthetics surgery a person feels worse, you should not expect the situation to normalize on its own. Only provided in a timely manner health care will help prevent severe complications.
Causes of complications after hip replacement
The operation is complex and traumatic, so it cannot always take place without negative consequences. To reduce the risk of complications, it is important to follow the doctor’s recommendations during the rehabilitation period after endoprosthetics. The following are at risk for postoperative disorders:
- elderly people over 60 years of age;
- those suffering from systemic pathologies, for example, diabetes mellitus, arthritis, psoriasis or lupus erythematosus;
- patients with a history of fractures or dislocations of the hip joint;
- patients suffering from chronic inflammatory diseases;
- violating the advice and recommendations of the surgeon.
In older people, complications after knee or hip replacement develop due to physiological characteristics. Because joint structures become thinner and deteriorate as the body ages, older people are at greater risk of developing Negative consequences. During the rehabilitation period, young men and women must use special devices when moving, because walking without crutches can cause dislocations or fractures of the prosthesis.
Types and symptoms
Paraprosthetic infection
A rise in temperature in the postoperative period may be a symptom of an infection. If a person has a fever after hip replacement, swelling, a purulent fistula has formed and is experiencing severe pain in the thigh, most likely an infection was introduced into the wound during the operation. For such symptoms, the doctor prescribes antibiotics and auxiliary products that can help relieve inflammation. If for a long time the temperature persists, but the patient does not consult a doctor and does not take any measures; repeated, revision endoprosthetics of large joints is possible.
Dislocations and subluxations
Often develops late rehabilitation periods when the patient ignores physical limitations and early refuses to move on crutches. Due to the increased load, the femoral component is displaced in relation to the acetabulum, causing the head to misalign with the cup. The damaged area swells and hurts, the person cannot take some familiar positions, the leg loses its functionality, and lameness is observed.
If discomfort has just begun to appear, it is better to immediately visit a doctor; the sooner you begin to eliminate the problems, the less consequences there will be.
Neuropathy
With neuropathy, a person may experience a feeling of numbness in the foot. If nerve fibers are damaged during surgery on the hip joint, neuropathic syndrome develops. This complication may be a consequence of lengthening the leg after installation of the implant or pressure on the nerve endings of the resulting hematoma. The main symptom of neuropathy is acute pain that spreads to the entire lower limb. Sometimes it feels as if the foot is numb or there is a burning sensation and a feeling of goosebumps running across the skin. With such symptoms, it is dangerous to endure pain and self-medicate. If you consult a doctor in a timely manner, you will be able to normalize your health with the help of physical exercises, otherwise you cannot do without surgery.
Periprosthetic fracture
After replacing the hip joint, the integrity of the bone structures of the hip may be damaged in the place where the endoprosthesis leg is fixed. This is often a consequence of decreased pelvic bone density or poorly performed endoprosthetic surgery. If a fracture occurs, the person experiences severe pain, swelling and hematoma form at the site of the injury, and the functionality of the joint is impaired.
Thromboembolism
The first days after endoprosthetics, the patient will be partially immobilized, as a result of which the blood flow in the veins and arteries will be disrupted. This leads to critical blockage of blood vessels with a thrombus. Often the condition does not have pronounced symptoms, so it is important to control blood circulation and not violate the doctor’s recommendations during the postoperative recovery stages. Sometimes, with thrombosis, the patient notices that the limb hurts and is swollen; shortness of breath, general weakness, and loss of consciousness may also bother.
Other consequences
If the prosthesis does not take root, the person may suffer from pain in the groin. Complications during endoprosthetics can be very diverse. One of the most common is the body’s rejection of the implant. After prosthetic surgery, the body may react inadequately to foreign material, resulting in inflammatory and allergic reactions. Swelling, suppuration and fistulas form at the implantation site. In addition, a person may experience:
- blood loss;
- loosening of the prosthesis structure;
- lameness;
- groin pain;
- edema, due to which the legs swell so that the function of the joint is completely impaired.
Hip pain, swelling, infectious inflammation, loosening of the prosthesis, impaired walking and lameness are not all the complications after hip replacement (HJ). An operation to replace a joint with an artificial one helps a person get rid of many problems, reduce pain, and return to their previous life. But the postoperative period does not always pass without complications.
It is important to go through the stages of recovery correctly, following the doctor’s recommendations, this way you can reduce the risks of developing negative consequences.
Possible complications
General violations
After endoprosthetics of large joints, the body's reaction can be unpredictable. Dangerous consequences rarely occur, but there are situations when the patient becomes ill and at this moment it is important to provide first aid in a timely manner. Common complications include:
- Allergic reaction to medications used during surgery. If the patient has any restrictions on taking certain groups of drugs, it is important to inform the doctor about this before surgical treatment.
- Impaired functioning of the cardiovascular system. Hip replacement is performed under general anesthesia and if the heart muscle is weak, anesthesia has a negative impact on its condition and can significantly impair performance.
- Problems with motor functions arising due to the body’s rejection of the prosthesis, which is a foreign object that causes a corresponding reaction.
Pain and swelling
Patients often suffer from pain after surgery. Afterwards, during the rehabilitation period, the patient may be bothered by unpleasant pain symptoms, which, with adequately selected therapy, should soon go away. You can get rid of discomfort by performing rehabilitation exercises. But when a limb hurts and a person gets worse, the doctor decides to do it, because often the cause of pain is an unsuitable prosthesis and an allergy to its material.
During the postoperative period, many patients experience swelling in the operated leg. Swelling in this case is a consequence of circulatory disorders and metabolic processes in a limb. To prevent this from happening, the patient is recommended to take comfortable positions while resting and awake that will not interfere with normal blood flow. Diuretics prescribed by your doctor will help you remove excess fluid better.
Infectious
Infectious and inflammatory complications often occur even in late rehabilitation periods; this is due to the proliferation of pathogenic microflora introduced into the wound during surgical procedures. The patient's legs become swollen and painful, and pus and blood clots are released from the wound. The temperature after hip replacement surgery increases to 38 °C and if treatment is not started in a timely manner, fistulas will form at the operated site.
To prevent infectious complications, after surgical treatment antibiotics are prescribed.
Trauma to a nerve or vessel
The patient may feel “pins and needles” on the leg if the nerve is damaged. If nerve tissue is injured, the operated leg may lose some of its functionality. There is a burning sensation and a feeling as if “goosebumps” are crawling across the skin. When the integrity of the vessels is violated, internal bleeding occurs, and the likelihood of developing embologenic deep vein thrombosis and inflammatory complications increases.
Different limb lengths
After hip replacement, the symmetry of the limbs may be disrupted. This complication is rare and is associated with long-standing injury to the femoral neck. If the bone tissue reconstruction technique has been violated, the length of the affected limb often changes. If this defect appears after surgery, it is corrected using orthopedic shoes.
Bleeding
Common complications after hip replacement in older adults taking wound-healing medications. Therefore, in order to avoid dangerous consequences, doctors recommend stopping taking such medications 4-5 days before the procedure. Less often, it happens that bleeding was caused by the surgeon’s negligence. Often the head of the endoprosthesis takes an incorrect position due to careless movements of the limb or increased physical activity. Therefore, after replacing a hip or knee joint, it is recommended to carefully walk on crutches, sit slowly on a chair or bed, and fix the hip joint and knees using an elastic bandage. Lameness may result from:
- An old fracture of a limb or joint neck, due to which the leg has become shorter after prosthetics.
- Atrophy of the muscle tissue of the leg due to prolonged immobilization.
