Home Removal Endoprosthetics according to compulsory medical insurance. Joint: replacement, quota and free endoprosthetics in Russia

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Endoprosthetics according to compulsory medical insurance. Joint: replacement, quota and free endoprosthetics in Russia

In order to perform a high-quality pelvic replacement operation hip joint and prevent large costs, it is possible to use a special quota. Until 2015, these privileges were provided to all patients who received prosthetics different types joints.

However, today numerous changes have been introduced at the legislative level, according to which a quota can be obtained primarily in the event that a surgeon made a mistake when replacing a hip joint, as a result of which the operation must be performed again. The benefit can also be used in other cases, for example, with certain types of systemic diseases.

It is no secret that replacing any joint is quite an expensive undertaking, which may not be affordable for many patients. At the same time, not only prosthetics are expensive, but also the purchase of a hip joint prosthesis.

As planned at the legislative level, from 2016, a quota in the form of allocation of funds for surgery should have been received under the Compulsory Health Insurance policy. However, on this moment this issue has not yet been resolved and is under discussion.

Meanwhile, doctors performing hip replacement surgery still cannot fully answer patients' questions and establish a reimbursement system.

Despite this, there are certain ways out of this situation that you can use if necessary. This will significantly reduce financial costs or completely cover the costs of surgery and the purchase of a prosthesis.

Today paid hip replacement surgery is performed by:

On the territory of a private clinic, and the patient pays for the prosthetics in full.
In a public medical institution, where you can receive compensation and spend less money.

Naturally, such expensive treatment in private clinics will not be provided for free. Here you have to pay for the operation and the purchase of a new artificial joint.

Also, the patient will need to pay additional financial resources for being in the ward, anesthesia, and purchasing necessary medications. Thus. Treatment on average will cost from 300 to 800 thousand rubles. It is clear that such an operation will be carried out at a high quality level.

In public clinics, if you’re lucky, you can get a certain benefit for prosthetics, which will allow you to perform the operation at a lower cost. In this case, the endoprosthesis is purchased by the patient independently. The privileges extend to conducting surgical intervention and being in a medical clinic.

According to current legislation, these expenses must be paid through the Compulsory Health Insurance policy. However, as mentioned above, today not all hospitals have adopted this system.

A controversial situation may also arise if the medical institution does not intend to collect and prepare the necessary medical and administrative documents.

Since some types of quotas currently remain in force at the legislative level, they can be used if necessary. This will allow the operation to be performed and a prosthesis to be purchased free of charge at state expense.

At the same time, documenting a quota is quite simple and in a short period of time.

To take advantage of the benefits, the patient must contact the medical clinic, provide the required set of documents and x-rays affected hip joint. Next, you should worry about obtaining the quota decision protocol, which is issued at the hospital.

After this, the following documents are provided to the Ministry of Health:

Quota decision protocol;
Application in writing;
Patient's testimony and identity;
Mandatory health insurance policy;
Certificate of state pension insurance;
Certificate of disability;
An extract with information about the patient’s condition, diagnosis and types of studies performed;
Results of laboratory tests.

After all documents have been provided, within a ten-day period a coupon for the provision of medical care and patient data is entered into overall plan on carrying out . Then you just need to wait for the stated turn to arrive.

It should be taken into account that the waiting period may vary, depending on the work system and workload of a particular medical clinic. In some cases, the waiting list can last about three months, and if the hospital is a large medical center, the waiting period can reach several years.

It is important to understand that the operation is performed free of charge using endoprostheses, which are currently available in the medical clinic. Therefore, no one can guarantee that the artificial joint will be of high quality and from a well-known manufacturer.

Meanwhile, according to doctors, first of all, the quality and effectiveness of hip replacement depends on the experience of the surgeon who performed the operation.

Even the most expensive and high-quality joint from leading manufacturers will not work fully if the doctor made any mistake during installation of the artificial joint.

If treatment is carried out under a quota, there is no guarantee that the operation will be performed by an experienced surgeon with many years of experience and high level qualifications.

Using an individual rehabilitation program

You can also purchase a high-quality endoprosthesis free of charge using an individual rehabilitation program. In this case, the operation, even on the territory of a leading clinic, will be carried out at the expense of public funds, as well as

To take part in an individual program and take advantage of the benefits, you need to consult with your attending physician who will help you register Required documents.

Unlike the first option, in in this case The system consists of full reimbursement of funds spent on prosthetics. After the operation is completed, at the time of checkout, a document is drawn up, on the basis of which the money is returned.

In other words, the patient must pay the full cost of the prosthesis being installed, but after some time the money spent is returned.

The advantage of using an individual rehabilitation program is that the waiting period in this case is noticeably shorter than when the patient contacts the Ministry of Health.
Today, the cost of a high-quality endoprosthesis ranges from 100 to 150 thousand rubles. The average waiting period is about three weeks.
The funds spent will be returned to the patient within a month after the operation.
The use of high-quality endoprostheses from leading manufacturers is also considered a big plus, so the patient can be confident in the quality of the installed artificial joint.

Which option should I choose?

Thus, there are two main ways to receive free medical care during prosthetics. However, it is very difficult to obtain a quota from the Ministry of Health today. As a result, the most acceptable option is considered independent acquisition endoprosthesis through a rehabilitation program, if finances and waiting time allow.

If there is no time to wait, in any case, the most profitable option would be to seek treatment at a public clinic. But in this case, it is important to carefully choose a medical clinic, study the experience of doctors and find out what prostheses are available in this medical institution.

Joint replacement, as well as other reconstructive orthopedic operations belong to high-tech medical care.

High-tech medical care is medical care performed using complex and unique medical technologies based on modern achievements science and technology, highly qualified medical personnel.

These types of medical care are provided free of charge in the manner determined by order of the Ministry of Health and social development RF “On the provision of high-tech medical care at the expense of the federal budget in federal medical institutions and in medical institutions under the jurisdiction of constituent entities Russian Federation and municipalities."

According to the Order, high-tech medical care under a quota in City Clinical Hospital No. 67 can be received by residents of the city of Moscow with permanent registration at their place of residence and having a compulsory health insurance policy.

Read in detail regulatory documents can be found on the website of the Priority National Project “Health”.

In order to be able to perform endoprosthetics surgery under the program of providing high-tech medical care in our clinic, you must:

1. Contact city clinic at your place of residence and receive a referral for consultation to City Clinical Hospital No. 67.

2. As directed by the city clinic, come for a consultation at the consultative and diagnostic center of City Clinical Hospital No. 67 (see).

3. After consultation with an orthopedic doctor, when the indications for endoprosthetics are established, you will be included in the register of those in need of surgery. You should leave us information on how to contact you - indicate several phone numbers where you can be contacted.

4. As your turn approaches, an authorized employee of the orthopedic department of City Clinical Hospital No. 67 will contact you and inform you of the date when you should appear for hospitalization at the clinic. Your personal visit to the Department of Health is not necessary; when your turn approaches, we will prepare all the necessary documents ourselves.

5. Before hospitalization, you need to undergo an examination in accordance with the necessary preoperative examination program issued to you (you can read it here).

6. The examination is carried out in your clinic at your place of residence or any other medical institution on an outpatient basis.

7. Hospitalization is carried out strictly at the appointed time, subject to availability everyone necessary tests and results of instrumental studies.

Joint endoprosthetics, or joint replacement, is popular surgery and current treatment of the joint. The procedure for replacing a joint is not cheap; most people do not have the opportunity to replace a joint at their own expense. At the same time, the current legislation in the Russian Federation in some cases allows for full or partial compensation of the costs of this operation.

Today we will talk about how you can replace a joint completely free of charge (or partially) under a quota, where and who to contact. At the bottom of the page we have selected for you interesting videos about the features of the operation, types of endoprostheses, how to choose an artificial joint that is optimal in terms of quality and cost of money.

Joint replacement: a commercial operation

According to the appendix to the order of the Ministry of Health of the Russian Federation dated August 12, 2013 No. 565n, today a quota can be obtained for the following diseases:

Oncological diseases that affect the musculoskeletal system in children and adults.
Joint defects developing against the background of systemic connective tissue diseases.
Post-traumatic/postoperative changes in the structure of the limb (fractures, dislocations, subluxations), combined with deforming arthrosis of the knee, elbow, ankle, shoulder joints.
Von Willebrand's disease, other diseases associated with the quality of blood clotting, which affect the structure of joints and ligaments. This also includes cases of fracture of the neck of the femoral joint, when other types of surgical intervention, except total arthroplasty, are contraindicated.
Infection of the area in the area where the endoprosthesis is installed.
Wear, complete/partial destruction of the endoprosthesis, or instability of its components.
Incorrectly fixed prosthesis.
Bone fractures near the installed endoprosthesis. The problem is relevant for older people, because bone tissue loses its strength with age.

In accordance with the above order and in accordance with the Decree of the Government of the Russian Federation of November 28, 2014 No. 1273, endoprosthetics hip joint under quota it is possible in the following cases:

The patient is diagnosed with deforming arthrosis in combination with postoperative injuries.
Joint dysplasia against the background of deforming arthrosis.

In other cases, patients must have the financial resources to install an endoprosthesis.

These costs can be reduced in the following ways:

Make a choice when treating a joint in favor of a public clinic. You can save on paying for the services of the attending surgeon and for hospital stay. The costs will be covered by the compulsory health insurance policy (CHI), but you will have to pay for the prosthesis. Sometimes the patient does not have enough time to collect the documents necessary for the operation, then the administration of the state medical institution may refuse to assist the patient in free operation. When a patient goes to a private clinic, he will be forced to pay for both the endoprosthesis and the operation.
Take advantage of an individual rehabilitation program.

Where to go, what documents are needed: stages of obtaining a quota for joint replacement surgery

The algorithm for receiving high-tech medical care for joint replacement for citizens in the Russian Federation is as follows:

First, who you need to contact - the attending physician at your place of residence. Most often this traumatologist-orthopedist, but you can just go to surgeon. He will schedule a full medical examination, which will confirm the presence of complex joint pathology, which will make it possible to receive a quota for free treatment.

Based on diagnostic data, test results and medical history, the quota committee of the specified clinic will draw up a protocol.

Second. After receiving the quota decision protocol from a medical organization, the patient needs to collect the following composition (package) of documents (copies):

Passport of a citizen of the Russian Federation.
Compulsory health insurance policy (CHI).
Pension insurance certificate (SNILS - insurance number of an individual personal account).
A document confirming disability (if there is a group - MSEC certificate).
Conclusion (including the original document) from the clinic stating that the person needs surgery. It should contain data on health status, diagnosis, all diagnostic activities carried out for the purpose of making a diagnosis.

Of the original documents, the patient needs to have with him:

Referral from a traumatologist-orthopedist (attending physician).
Quota decision protocol.
Written statement from the patient.

Third. With the collected complete package of documents, the patient or his authorized representative must contact the health department, where the received application is considered with the participation of a specialist in the field of “Traumatology. Orthopedics".

Often the patient himself is not present at these meetings, but if controversial situations arise, he may be called for an in-person consultation.
The entire process of considering the application, according to current legislation, takes no more than ten days.
When the commission meeting makes a positive decision, all the patient’s documents are sent to the clinic that performs joint replacement surgery under a quota.
Any such clinic has a quota committee, which, after reviewing the received package of documents (within ten days), reports to the health department the exact date hospitalization.
So oh the decision taken The health department is informed, and an employee of this department informs the patient by telephone about the appointed date.

It is not possible to say exactly how much time will pass from the moment you receive a coupon for high-tech medical care (HTMC) to the operation. Much will depend on popularity medical clinic, which carries out joint replacement surgeries (workload of patients); settlement. In big cities, waiting in line can take several months.

To whom and how are quotas for free surgery given?

An individual rehabilitation program (IRP) makes it possible to compensate for the cost of an endoprosthesis in the following cases:

The patient has a disability for the disease in question.

Endoprostheses at the expense of the federal budget are provided only to those disabled people whose right to receive endoprostheses in the IPR came before 01/01/2015. It does not matter in what year the operation will be performed: in 2016 or 2017. But there is a nuance: for this category of patients, a fixed amount is allocated for the operation and endoprosthesis (on average 160 thousand rubles).

If the IPR was received after December 31, 2014, endoprosthetics is carried out at the expense of compulsory medical insurance (compulsory health insurance policy). According to the order of the Government of the Russian Federation dated January 1, 2015 No. 1776-r (clause 8), endoprostheses are excluded from the list of rehabilitation funds that the state allocates to disabled people. An individual rehabilitation program makes it possible to receive free certain means rehabilitation: walkers, crutches, diapers, etc. On the other hand, at present the procedure is not normatively regulated for reimbursement of the cost of operations for compulsory medical insurance policy. There are many controversial issues that will take the patient a lot of time to resolve. Therefore, when an urgent operation is needed, people are forced to seek help from charity organisations, funds.

Registration of an individual rehabilitation program for a disabled person is carried out on the basis medical and social examination(ITU). When passing the examination procedure in ITU Bureau the possibility of inclusion in the IPR is being considered technical means rehabilitation.

Joint replacement in Russian clinics: how much does it cost?

The cost of the procedure depends on several factors:

First:type of medical facility: in public clinics, fees are more often charged for endoprostheses. In private hospitals, one treatment for a patient can cost at least 100 thousand rubles (without an endoprosthesis).

This price includes:

Operation.
Anesthesia.
Nutrition.
Hospital stay (4-5 days).

The cost will also be affected locality, surgeon's qualifications.

Second: type of endoprosthesis, manufacturer.

If you take ceramic/ceramic and metal/metal friction pairs (from 170 thousand rubles) they will cost more than metal/polyethylene pairs (about 130 thousand rubles).
Prices for a total cement endoprosthesis range from 120-140 thousand rubles.
Cementless structures are 40-50 thousand rubles more expensive.

Third: type of surgery.

For example, total arthroplasty costs twice as much as partial arthroplasty.
The most expensive manipulation is an operation on hip joint(it is a large, supporting joint).
Surgery shoulder joint 5-7 thousand rubles cheaper, knee joint - 10-15 thousand rubles cheaper.

Fourth: diagnostics. Before the operation begins, the patient undergoes a lot of tests, X-ray examination. State clinics for research data they are often sent to private medical organizations– these are additional costs.

Video

Joint replacement: service life of endoprosthetic replacement joints

The video shows the CELT Multidisciplinary Clinic.

Are you going to undergo joint replacement surgery? Doctor of Medical Sciences, orthopedic traumatologist, will tell you about the service life of an artificial prosthesis. Multidisciplinary clinic CELT.

Another question that we would like to consider and which, for sure, worries patients when they come for consultations with a doctor, they are offered surgery to replace a joint with an artificial one, is what is the period of functioning or survival of the joint, what life span can a person expect, having an artificial joint... Joint replacement.

First aspect- This is the attachment of the components of an artificial joint to the bone. It is carried out in two main ways: by firmly hammering the components into the bone tissue, where, thanks to the porous surface that the implant has, a gradual ingrowth of bone beams occurs and the so-called process of osseointegration is formed.

Due to this process, the elements of the joint are very firmly fixed in the bone and, most importantly, for a long time. This is called the so-called biological fixation of the implant.

If the quality bone tissue patient (osteoporosis or some other problem) does not allow this kind of biological fixation, then immediate fixation is carried out using a special hardening mass called “bone cement”. This is the doctor’s choice depending on the clinical situation he has... Knee replacement.

Second aspect endoprosthetics, which we encounter is a friction pair.

Each artificial joint is a hinge where there are rubbing components. In the absence of any lubrication, as happens in a technical device, there is a coefficient of friction and corresponding wear of the components between which friction occurs in the joint. And the degree of wear of these components also determines the survival of the joint in the human body.

The degree of wear depends both on the materials used in the friction pair and on the number of motor cycles that a person performs during the operation of the artificial joint.

Increasing the survival time of a joint is in two ways: firstly, by improving the quality of friction pairs and in some cases it may be by reducing the cyclic activity of the joint, which is not needed by a person in his everyday life and only leads to early wear of the joint. Currently, in particular for some joints, such as the hip joint, friction pairs such as ceramic friction pairs already exist and are used, including in the CELT clinic, which, in terms of their wear capabilities, can exist in periods comparable to patient's life... Hip replacement.

In our practice, there are also friction pairs where special ultra-high molecular weight polyethylene is used... Shoulder joint replacement.

In order to select an endoprosthesis of the required quality, adequate to the condition of the patient’s bone tissue, his age, and his functional capabilities, it is necessary to contact very qualified specialists... Knee joint prosthesis.

How to choose the right endoprosthesis

On the video channel INFOX Media Group.

Several years ago, surgeons had only five types of endoprostheses in their arsenal. Today in Europe there are about seventy different options. For each patient, depending on age, gender, body configuration, an endoprosthesis is selected individually.

Endoprosthesis: what is worth paying for, what is not!

On the Medinua Clinic video channel.

MedinUa clinic&LAB is a multidisciplinary family medicine center where only advanced technologies are used - invasive surgery, techniques from the field sports medicine, which contribute to the effect of early rehabilitation.

Endoprosthesis replacement is a very successful procedure for overcoming the consequences of joint diseases that cause degeneration and wear of articular cartilage. Patients note a decrease in pain, an increase in the range of available movements and a general improvement in well-being. Naturally, the demand for such procedures has been growing in recent years, so the question of the cost of hip replacement and other cartilage joints is relevant for many.

On the left of the image you see a correctly installed endoprosthesis of the right hip joint. This is the most common method of replacing the TBS; it is the most durable and strong.

In this image, the operation was performed in a superficial manner, in which most of the bone tissue was preserved. Many people mistakenly think that this method of surgery is preferable, despite the fact that it is more expensive. But a big problem is that it uses a metal head femur, which wears out and oxidizes and inflames the surrounding tissues.

When is endoprosthetics necessary?

The main indications for this species surgical intervention are extreme, advanced forms of joint diseases (arthritis and arthrosis), consequences of severe injuries:

osteoarthritis(deforming arthrosis). Due to deformation and wear, the cartilage is destroyed and the joint takes on an irregular shape. The patient has severe painful sensations, stiffness in the joint, the range of available movements is reduced;
aseptic necrosis or bone destruction. Can be called as various types injuries, and a number of other reasons;
neck fracture hips. Most often occurs in older people. The main risk group is post-menopausal women. Because of age-related changes Hormonal levels change, bones become fragile. The likelihood of spontaneous fusion in people after 65 years of age is practically absent;
rheumatoid(inflammatory) arthritis. Affects large and small joints, most often knee and hip. Accompanied constant pain, stiffness and swelling in the affected area.

If at listed diseases conservative therapy no longer helps, and painkillers provide a temporary, gradually decreasing effect; most often, in the absence of contraindications, installation of an artificial implant is recommended.

Cost formation

The cost of this procedure can vary significantly even within the same country. The actual price for prosthetic replacement of a joint, femoral neck or other cartilaginous joint, announced to you by the clinic, depends on many factors, including:

general time spent in hospital. Depends on the type of surgical intervention, the general condition of the patient, and the presence of concomitant ailments. For example, if we consider hip replacement, total, superficial or bilateral prosthetics can be performed. The price in the latter case is much lower;
used implant(means the material from which the prosthesis is made);
surgical techniques use of individual tools or specialized computer technologies);
the need for preliminary hospitalization. You may need additional care in the hospital, certain precautions during the surgical procedure;
type of anesthesia used. It can be local, spinal or general;
unexpected costs associated with possible complications.

Hospital stay

When clarifying the prices of a particular clinic, do not forget to ask questions such as: “Does the cost of hip replacement that you are quoting include the time of stay and all procedures performed in the hospital?” This clarification is not accidental, otherwise an unpleasant surprise may occur. For example, in the United States, as can be seen from our summary table, the cost of replacing a hip joint starts at $40,000, but none of the clinics takes into account in their prices the approximately $7,500 payment for the procedures that you will undergo during your hospital stay.

In the absence of insurance and benefits that can cover all or part of the cost of treatment, a number of clinics offer discounts and are developing individual plan payments. Be sure to think about this point at the treatment planning stage.

Additional expenses that may increase the cost of a hospital stay:

painkillers;
injections of antibiotics and anticoagulants, designed to reduce the likelihood of complications, the development of infections and the formation of blood clots;
use of additional computer or other technologies during surgery;
physiotherapeutic support;
consultations with a rehabilitation specialist.

Outpatient treatment costs

A significant portion of the cost of replacing the hip joint and other cartilage joints is the inpatient procedure and hospitalization. However, keep in mind that you will also have to spend money on the outpatient part of the treatment.

These additional costs include:

pre- and postoperative consultations, laboratory tests;
routine visits to an orthopedic surgeon during the recovery period.

Post-surgical care

Experts recommend that the recovery and rehabilitation period be carried out in specially equipped medical centers, where the patient will stay from 2 to 4 weeks. At the same time, he is placed in a ward equipped for all his needs, under vigilant control junior medical personnel, performs a set of exercises written specifically for him. As you understand, the services of such centers are far from free. Their average prices are about $250 per day, this amount may vary depending on the country and location, and the level of equipment of the institution.

The indicated price includes:

outpatient physical therapy services;
instruments used during procedures;
ward (24-hour stay or day hospital);
three dietary or vegetarian meals a day;
adaptation and psychological assistance.

Additional expenses

The cost of treatment and adaptation costs are not all that you will have to fork out for. Your doctor will likely recommend purchasing special equipment, such as passive mobility aids (walkers, crutches). In some cases, their cost may be covered by insurance, but in general such expenses fall entirely on the shoulders of the patient or his relatives.

Additional costs you may expect:

crutches, walkers, canes;
compression stockings;
shower bench;
toilet chair with removable bucket.

Depending on the patient’s condition and the ability of his loved ones to provide support and assistance during the postoperative period, he may still have to pay for the services of a nurse.

Average cost of hip replacement

Type of procedure	Prices for prosthetics
Type of procedure	Germany, thousand euros	Israel, thousand USD	Canada, USD	USA, USD	Cuba, USD
Hip replacement, price	From 13.5	From 26	From 25	From 40	From 10
Knee replacement, price	From 14.5	From 23	From 22	From 35	From 7.8
Shoulder joint replacement price	From 15	From 20	From 20	From 35	From 8

Note that when using minimally invasive techniques, costs are somewhat reduced. So the price for total hip replacement will be 20-25% more expensive than for partial. The fact is that with an incomplete replacement, recovery is faster, therefore, the costs of your hospital stay and painkillers will be reduced.

Also keep in mind that pure hospital expenses are not the entire amount that you have to shell out out of pocket.

The total cost of total hip replacement or other cartilaginous joint replacement, in addition to the operation itself, includes the following pre- and post-operative expenses:

preoperative doctor visits and tests;
the actual surgery and the time you spent in the operating room, including the cost of anesthesia and other instruments used;
hospital stay;
post-operative visits to the doctor;
physiotherapeutic procedures;
services of rehabilitation and recovery centers.

Cost of prosthetics in Moscow

To perform joint replacement, it is not necessary to go abroad; it can be performed efficiently and reliably in Russia. True, in Moscow it is much easier to find a medical institution with a good reputation, modern equipment and competent specialists than in the regions. And there are more quotas for free treatment, as well as partial compensation, in the capital.

Treatment in Moscow is not always a good solution; often, for comparable funds, you can receive much better treatment in other clinics, cities, or even countries.

Each patient chooses a clinic based on the capabilities of their own wallet. Are you interested in how much hip replacement costs in Moscow? Often the price of such procedures exceeds the cost of treatment in European clinics. In our country, unlike Western countries, endoprosthetics has not yet been put on stream; it belongs to the category of the most complex, high-tech procedures. Accordingly, it cannot be cheap. Moreover, the range of prices in the capital’s clinics is quite large, as is the difference in the quality of services provided.

Procedure name	From	Before
Single-pole hip arthroplasty, price thousand rubles.	24,3	200
Total hip replacement, price thousand rubles	23,2	410
Revision hip replacement, price RUR	20,3	450
Reduction of dislocated prosthetic head (non-surgical)	5,1	25

To be completely clear regarding pricing policy Moscow clinics, we will also answer the question of how much knee replacement costs in Moscow.

Features of domestic insurance

The program for financing medical services in Russia is single-channel. That is, when an endoprosthetics operation is performed under a compulsory health insurance policy (CHI), it covers the treatment itself and the cost of the implant. This means that you will not be able to buy separately a more suitable, high-quality prosthesis when financing anesthesia, surgery and medications with a compulsory medical insurance policy. All that is available to you is an additional payment for non-medical services, such as a more comfortable room, improved food.

A quota - on the one hand, allows you to receive treatment for free, but on the other hand, it is not entirely free. Or not at all free.

When concluding an agreement with a clinic for paid medical services, the full cost of hip and other joint replacements is paid by the patient or his relatives. But you will have to pay for the implant itself, the operation, the ward, anesthesia, medications, IVs and all other procedures.

If you have a policy voluntary insurance the entire range of costs for endoprosthetics is usually paid by Insurance Company. In some cases, but not always, she can pay for the cost of the prosthesis for you. Be sure to check this point with your consultant.

Paid surgical treatment

This method of installing an artificial implant is the fastest. There are several options for performing the operation:

V private clinic . You will need to pay for an operation to replace a shoulder or other joint, the price for which is stated in the price list, and the costs will also include each bed day, the cost of the selected endoprosthesis, medicine;
in a public medical institution. Treatment is carried out according to the compulsory medical insurance and voluntary medical insurance policies. However, in a number of clinics, additional payment for a number of services may be required.

Quota operation

Until recently, endoprosthetics procedures were carried out in Moscow according to a budget quota program, when the state assumed all costs for such high-tech operations. Unfortunately, since 2014, the volume of quotas has been significantly reduced, and it is becoming increasingly difficult to obtain them.

The general sequence of actions looks something like this:

provision to a medical institution x-rays affected and healthy joints, all necessary statements;
when the diagnosis is confirmed, if the selected medical institution has quotas, you will be given a “Quota Decision Protocol”;
Having taken the protocol, the compulsory medical insurance policy and documents confirming your identity, you must go to the city Ministry of Health, where, within the established period, they will issue a coupon for the provision of medical care, and your personal information will be included in the operational plan;

Then there are many months ahead that must wait until the date of the operation. Most often, it occurs after about a year (the exact period depends on the level of the clinic).

Such a long wait, which you have to spend tete-a-tete with your illness, is the main drawback of the budget quota program. Also, before lying on the operating table, you should ask yourself a few questions:

What kind of endoprosthesis is installed according to the quota? It is not chosen based on your individual anatomical needs, but rather those that are available at the time of the operation are installed;
Who is my surgeon: an experienced specialist or yesterday’s student? The effectiveness of the operation depends largely on the experience of the orthopedist performing it. Even if you get the best of the best prostheses, it is not a fact that a young doctor will be able to install it as needed.

Endoprosthetics according to IPR

Using an individual rehabilitation program as an alternative to quotas, which, as we have already mentioned, are now very difficult to obtain, you can save significantly. You will be provided with a high-quality biocompatible prosthesis in a qualified Moscow clinic at a budget expense.

Types of endoprosthetic friction parts from left to right: ceramics-polyethylene, metal-metal, ceramics-polyethylene, ceramics-ceramics, ceramics-polyethylene.

The design of the program is carried out by the Bureau of Medical and Social Expertise, for participation in IPR program you must have a registered disability. Within the framework of the IPR, the necessary measures and means that can serve in favor of the patient’s rehabilitation are prescribed. For people with coxarthrosis and gonarthrosis, this is in most cases endoprosthetic replacement of the affected cartilage joint.

The porous surface of the endoprosthesis components allows the parts to be attached to the bones without cement. This is the most preferred method of implant placement.

If you have a valid IPR in hand, you can receive compensation for installed prosthesis. True, initially its cost will need to be paid into the bank account of the manufacturing company from your own pocket. This money will be returned to you later.

Bottom line

As you can see, there are several ways to reduce the cost of prosthetics. Therefore, you should carefully study all aspects of the upcoming procedure, find out what is included in the prices of the chosen clinic, think about equipping your own home and how and where your rehabilitation period will take place.

Be sure to consult your doctor before treating any illness. This will help take into account individual tolerance, confirm the diagnosis, ensure the correctness of treatment and eliminate negative drug interactions. If you use prescriptions without consulting your doctor, it is entirely at your own risk. All information on the site is presented for informational purposes and is not a medical aid. All responsibility for use lies with you.

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The formation of the hip joint (HA), which is a simple synovial joint, occurs with the participation of two articulating bones - the ilium and the femur.

The cup-shaped depression on the outside of the pelvic bone (acetabulum) and the ball-shaped bone of the femoral head together form the hip joint, which is a kind of hinge structure.

The femoral head is connected to femur neck, which is popularly called "femoral neck". The inside of the acetabulum and the femoral head itself are covered with a layer of special articular cartilage (hyaline).

Cartilage is an elastic and, at the same time, durable and smooth layer in the joint. Provides gliding during joint operation, releasing joint fluid, distributing the load during movement and the necessary shock absorption.

Around the head of the joint there is a capsule consisting of very dense and durable fibrous tissue.

The joint is attached to using:

Bundles. The external ones are attached at one end to the femur, at the other to the pelvic bone. And the internal ligament of the head of the pelvic bone connects the head itself with the acetabulum of the pelvic bone.
Muscle They surround the hip joint - the buttocks at the back and the femurs at the front. The better the muscular framework of the joint is developed, the less traumatic loads on it when running, unsuccessful jumps and moving heavy objects. It is also important that a good volume of strong working muscles delivers a sufficient volume of blood nutrients joint.

With the help of the hip joint, a person is simultaneously provided with such functional possibilities:

body stability (support, balance);
variety of movements.

Why is the joint affected?

Obvious causes of damage include. Examples are, dislocation of the vehicle or its.

Non-obvious diseases (infectious and non-infectious arthritis, osteoarthritis, inflammatory processes in the joint and periarticular tissues).

In this case, over time, various complications develop, which are expressed in damage to the components of the pelvic joint - cartilaginous tissue, capsular, bone.

Let's consider main ones:

inflammation of the pelvic joint - usually caused by arthritis of various etiologies, bursitis, synovitis, etc.;
pathology of joint deviation – dysplasia;
necrosis in the head of the TM of some parts of the bone marrow - non-infectious necrosis (avascular).

When and who needs a hip replacement?

The occurrence of pain in the hip joint is a signal that you should contact a professional to determine its causes. To do this on initial stage You should undergo an X-ray examination of the vehicle.

Solving the problem for a worn-out or irrevocably injured joint, endoprosthetics can be used, which may be indicated in such cases:

non-healing fracture of the head of the vehicle;
fractures of the femoral neck or acetabulum in elderly patients;
tumor-like diseases of the TS;
deforming arthrosis of the third stage;
congenital hip dislocation, etc.

What types of operations does medicine offer?

In modern medicine, patients are offered the following types of prosthetics: three types of operations:

Replacing vehicle surfaces– removal of cartilaginous layers from the acetabulum and replacement with a special artificial material and grinding of the head of the femur and putting a metal cap on it. Thanks to this replacement of articular surfaces, gliding is achieved that is close to natural.
Partial prosthetics– replacement, for example, of the head of the pelvic joint with part of the femoral neck, articular bed.
Complete prosthetics– removal of the entire hip joint and replacing it with an endoprosthesis.

Types of endoprostheses

IN modern medicine Every day there are more than six dozen modifications of endoprostheses. They are divided according to the method of fixation and material. Fixation methods are offered today three:

cementless – fixation occurs due to the fact that the joint bone grows into the surface of the joint;
cement – the endoprosthesis is fixed using special bone cement;
mixed (hybrid) - the cup is attached without bone cement, and the leg is attached with cement.

Modern combinations of materials from which prostheses are made are selected depending on the patient’s disease, age and lifestyle. They can be are:

metal – metal;
metal - plastic of very high quality;
ceramics – ceramics;
ceramics - plastic.

Preparing for surgery

All necessary information to prepare for surgery will be provided to you by your attending physician.

However, there are moments for which the patient will have to prepare in advance (especially those who are lonely).

Since rehabilitation after a joint replacement has been performed continues at home, it is worth preparing your home for postoperative period recovery:

purchase special equipment in the form of walkers or crutches, a special toilet seat, etc.;
stop taking certain medications (aspirin-containing, anti-inflammatory);
if necessary, reduce your weight;
do physical training;
visit the dentist;
give up bad habits(smoking).

Typically, hospitalization is carried out 2-3 days before surgery. These days are needed to conduct an in-depth examination of the patient - comprehensive blood tests, studies existing diseases with consultations from relevant specialists.

Before surgery the patient is obliged draw up the necessary documents (carrying out an operation in cash, under a contract within the framework of medical insurance or according to quotas federal program provision of free high-tech medical care); talk with an anesthesiologist about the most favorable anesthesia option for you; Stop eating at least 12 hours before surgery.

Joint replacement surgery

Modern advances in medicine make it possible to carry out both open operations for hip replacement, both minimally invasive and minimally invasive.

Be careful, photos are 18+! Click to open

Today, minimally invasive surgeries (MI) are the most common due to their minimal impact on the body.

To conduct MO required:

high qualifications and professionalism of the surgeon and all medical staff;
availability of technical capabilities ( endoscopic equipment, high-tech materials).

Depending on the complexity of the operation (partial or complete prosthetics), its time can last from one to three or four hours:

anesthesia;
installation of a catheter in urethra(to prevent involuntary urination and control the amount of fluid released by the body);
an incision on the outer thigh (or two small ones - on the thigh and in the groin area);
peeling and shifting of tissues around the vehicle;
installation of a prosthesis;
restoring tissue integrity and suturing the wound.

The video clearly shows how hip replacement is performed.

Be careful, video of the operation! Click to open

Possible complications

Any surgical intervention in the body may have its own Negative consequences. Complications after the procedure most often occur in operated on:

with large joint deformation;
with obesity or large muscle mass;
having a number of serious concomitant diseases– diabetes, diseases of the blood, heart and the entire cardiovascular system, etc.

Joint replacement can cause such complications:

incorrect position of the endoprosthesis;
damage to nerve fibers and arteries;
disruption of the postoperative wound healing process;
the occurrence of infections;
fracture of the femur, dislocation or “popping out” of the prosthesis;
thrombotic phenomena in deep veins.

Rehabilitation after surgery

Rehabilitation after endoprosthetics can be long and take up to 6 months.

Patient must conduct surveillance behind the seam, body temperature and your feelings. Pain during this period may pass and return; the patient must be prepared for this and make efforts to full recovery motor functions of the body.

First few days the patient is prescribed painkillers, anti-inflammatory drugs.

Further rehabilitation after hip replacement consists of special light exercises and breathing exercises.

To prevent cicatricial tightening of tendons and skin, to strengthen the muscle frame around the prosthesis for the patient appointed physiotherapy (physical therapy).

As indicated by reviews from patients who have undergone endoprosthetics, it is worth adhering to the recommendations of specialists as much as possible and then rehabilitation will be quick and almost painless.

Recommendations from specialists on how to move and sit, what kind of load to allow during the rehabilitation period (strength loads - running, jumping - remove, swimming) will allow patients to return to normal life activities in the shortest possible time.

How rehabilitation goes after hip surgery is described in detail in the video.

Where can I have surgery in Russia?

The operation of hip replacement is a high-tech process.

In 2015, the inclusion of high-tech medical care (HTMC) in the compulsory health insurance system was provided for by the new legislative draft “On Compulsory health insurance in the Russian Federation."

Therefore, here we will not specify who will pay for the operation - the patient or the insurance companies.

Hip Replacement Cost consists of the prosthesis and the operation itself. Today, the cost of surgery (total hip replacement) ranges from 210 to 300 thousand rubles(depending on the cost of the prosthesis).

Replacement hip joints in Russia they do it like in the federal budgetary institutions healthcare (FC of traumatology, orthopedics and endoprosthetics, regional clinical hospitals, research institutes) and in private clinics of the Russian Federation.

For example: