How long can a fever last after endoprosthetics? Pain after hip replacement

If you follow the rules of antiseptics and perform rehabilitation measures, complications after knee replacement rarely develop. However, even the most thorough preparation for surgery and its correct implementation cannot completely protect the patient from undesirable consequences. Postoperative problems reduce a person’s quality of life, contribute to dysfunction of the knee joint and require repeated surgical intervention.

Complications after knee replacement are divided into early and late. The first ones occur when an infection occurs, incorrect installation of parts of the prosthesis, or low blood clotting. The cause of early consequences may be non-compliance with doctor’s instructions and refusal to perform special exercises. In a later period, complications after surgery develop due to the destruction of bone tissue. Allergic reactions to the materials from which endoprostheses are made are much less common.

Postoperative pain syndrome

Knee replacement is performed to eliminate discomfort and restore joint mobility. After prosthetics, the patient is able to move independently and stop taking medications. However, it also happens that after surgery there is pain in the knee, which is accompanied by an increase in temperature, swelling and crunching.

Pain after knee replacement may indicate:

• the addition of a bacterial infection;
• development of synovitis;
• contractures;
• joint instability;
• other dangerous complications.

The type of pathology is determined based on the nature of the discomfort. Purulent inflammation is accompanied by fever, headache, and general weakness. A person’s leg hurts a lot, the skin turns red and becomes hot. The pain is pressing, ointments and tablets do not help in this case.

Increased local temperature and swelling of the knee are explained by the accumulation of purulent contents and the development of acute inflammation.

In the presence of contractures, the mobility of the knee joint is impaired. The pain has a mild aching character, it intensifies when walking.

With thrombophlebitis, the discomfort is bursting in nature. If a person after endoprosthetics notices that the knee is hot, severe pain and convulsions, he should consult a doctor immediately.

In some cases, repeated surgery is prescribed to eliminate the cause of the discomfort, or drug therapy. The pain may be associated with irritation of the nerve roots, in which case it disappears after a few months.

Infectious diseases after endoprosthetics

Such complications occur in the postoperative period in 4% of cases. In the first months after surgery, infection develops as a result of bacteria entering during the installation of the prosthesis. Pathogenic microorganisms penetrate tissues by contact or aerogenous means. Experts believe that infections are most often found in a certain category of patients.

Inflammation, fistulas, swelling and other consequences most often occur against the background of:

• obesity;
• diabetes mellitus;
• rheumatoid arthritis;
• immunodeficiency.

The prognosis may worsen if the operation was performed by an inexperienced surgeon and it lasted more than 3 hours.

Infectious diseases at a later time arise due to the penetration of bacteria through the hematogenous route. This is facilitated by the presence of chronic inflammatory foci in the body.

Therefore, before surgery it is necessary to cure caries, intestinal infections, and diseases of the genitourinary organs.

The severity of symptoms depends on the activity of the bacterium and the time of development of the pathology. Expressed symptoms purulent inflammation observed in 50% of patients. The rest are worried about the persistent pain syndrome, which intensifies when the knee is bent.

Fighting infection in an endoprosthesis requires an integrated approach. The most effective method is to remove the implant followed by cleansing the wound.

Along with this, antibacterial drugs are prescribed. The use of immunostimulants increases the effectiveness of treatment. Conservative treatment of infectious diseases is possible only if they are detected in a timely manner, the activity of the pathogen is low, and there are contraindications to surgery. In most cases, recurrence of the pathology is observed.

Dislocation of the prosthesis

This complication is observed quite rarely. The main reason is considered to be the patient’s incorrect behavior during the rehabilitation period and the specific structure of the prosthesis. Implant components may become dislodged in the first months after surgery. Dislocations most often occur after:

• repeated joint replacement;
• falls;
• blow.

The main symptom of this complication is dysfunction of the knee, accompanied by severe pain. The displaced part of the endoprosthesis compresses the surrounding tissue, which contributes to the development of inflammation.

Treatment of a dislocation can be carried out in several ways. Closed reduction is considered the simplest. However, after it the complication often occurs again. In this case, arthroplasty or revision prosthetics is prescribed.

Contracture

Contracture is a dysfunction of the joint, accompanied by nagging pain and difficulty walking. The operated knee takes a forced incorrect position. The cause of contracture is considered to be refusal to perform gymnastics. As a result, muscle tone decreases and their functions are impaired. The spasm prevents the knee from bending and straightening. Most often, temporary contractures disappear spontaneously.

If long-term immobilization of the joint is necessary, the likelihood of developing such a complication increases. To get rid of persistent contracture, surgical intervention is prescribed.

Prevention of pathology consists of following a regimen of physical activity and performing special exercises. They help strengthen muscles and restore their functions. The therapeutic course includes massage and physiotherapeutic procedures.

Development of thrombosis

Internal venous thrombosis is found in half of patients undergoing knee replacement. In 2% of cases, thromboembolism develops, which can be fatal. The high likelihood of complications has forced specialists to develop effective preventive actions that are included in the surgical protocol. The risk group includes:

• patients over 75 years of age;
• obese people
• diabetes mellitus;
• oncological diseases;
• patients taking hormonal drugs.

During surgery, enzymes begin to enter the blood, increasing its coagulability. This means that the formation of blood clots begins at this time. In half of the cases, thrombosis is detected on the first day, in 75% - in the next 2 days after prosthetics.

To prevent this complication, medication and orthopedic methods are used. The latter include:

• compression underwear;
• physiotherapy;
• electrical stimulation.

Oral anticoagulants are considered the most effective medications. They are taken within 14–35 days.

Allergy

Allergic reactions to materials used to make prostheses occur in every 10 patients. The main allergens are nickel, cobalt and chromium. Their contact with body tissues promotes the formation of salts, which gradually poison the body.

The main symptoms of allergies are pain that extends from the knee to the foot, redness of the skin and itching. People who are prone to allergic reactions, before the operation must undergo special tests. In such cases, it is necessary to select implants made from safe materials.

Errors in the installation of the prosthesis and bone destruction

Knee instability is considered the most common complication of total knee replacement. The reason is considered to be a violation of the sliding of parts of the prosthesis due to its incorrect installation. The incidence of complications does not depend on the type of prosthesis and the qualifications of the surgeon. To eliminate instability, a repeat operation is prescribed.

Osteolysis is a pathological process characterized by the destruction of bone tissue in contact with the prosthesis. The main cause is considered to be osteoporosis. Over time, the prosthesis becomes loose and loses its functions. Mobility of the implant can be caused by the destruction of the substance used for fixation. In this case, the patient experiences pain when moving.

Non-infectious loosening of the implant develops in the late postoperative period. It is considered the main indication for a new surgical intervention, during which an implant with long legs is installed. Medications are used to prevent instability.

Pain after knee replacement – ​​should you panic?

The main reason for prescribing knee arthroplasty is incessant pain and inability independent movement. The decision about surgery is made jointly by the doctor and the patient if conservative treatment does not bring positive results. Any intervention, even if it is performed under appropriate conditions by an orthopedic surgeon with extensive experience, is stressful for human body. A wound, even properly treated and sutured, reacts to aggressive invasion with pain, swelling, and infectious diseases.

After the operation, the pain will go away for some time, the endoprosthesis will “take root” and will no longer feel like a foreign body, and the inflammation will subside. For this purpose, inpatient observation and intensive drug treatment are recommended for the first time. Further “home” rehabilitation depends on the efforts of the person, his desire to start full life, self-confidence and a positive attitude towards a speedy recovery. If painful symptoms appear longer than a month after discharge from the hospital, a visit to an orthopedist is required.

Counting on an instant miracle is wrong. Pain at first after surgery is normal, no need to panic. Just ours biological system adapts to new conditions. To relieve pain and restore natural kinematics, rehabilitation measures are carried out both in a hospital setting and after discharge.

Thanks to modern developments in surgery and the use of minimally invasive techniques, damage to healthy tissue is minimized, which reduces risks. Swelling, a sharp increase in temperature, stiffness and severe pain after knee replacement occur only in 1.3-1.6% of patients.

Types and signs of postoperative complications

The worst thing you can do is tolerate it or self-medicate. Discomfort and lack of positive dynamics are a reason to urgently consult a doctor. The use of traditional methods of treatment and the use of pharmaceutical drugs (tablets, ointments) reduce pain symptoms, but do not eliminate the problem.

Particularly unforeseen consequences threaten those who listened to the advice of “experienced” people not on specialized forums or on social networks, but near home. Old ladies with the best intentions (and commercials) offer ways to heal. The peculiarity of the Slavic worldview is that it will go away on its own; it does not work in the case of endoprosthetics. “Miracle” drugs and “grandmother’s” methods help, of course, but extremely rarely. In most cases, such assistance results in new hospitalization and large financial expenses.

Contracture

It occurs extremely rarely (0.1%), since individual prostheses are used for implantation, taking into account age, anatomical and gender characteristics, but there are precedents. Swelling in the area of ​​the surgical field, impaired support function, joint pain are signs of the development of the disease. Ignoring the symptoms leads to shortening of the leg and lameness.

Contracture can be temporary or permanent. A decrease in kinematics or complete immobility is possible. A person consciously strives to reduce discomfort, so in the postoperative period he tries to move his leg so that it does not hurt. Rehabilitation requires regular loads of a certain nature. If they lack natural blood flow and healing slows down, the pathology leads to scarring and a permanent form.

Prescribing a treatment regimen is the responsibility of a specialist. Forced flexion/extension or lack of movement will only expand the affected area.

• physical therapy and massage;
• electrophoresis, physiotherapy;
• fixation of the joint with a plaster bandage;
• absence of overvoltage, heating, hypothermia;
• control over the state of the body: proper nutrition, absence of bad habits.

If you have been diagnosed with contracture, you should not cross your legs or begin walking without the help of a qualified professional. Also, with such a deviation, it is better to follow a diet - excess weight leads to progression of the disease.

Detected in 0.3% of patients. Features: the knee hurts, the leg swells, the pain does not stop even after a course of medications and physiotherapy. Inflammatory processes of the joint membrane are characteristic, as a result of which bursa filled with liquid.

Recovery is individual for everyone, depending on the characteristics of age, gender, general indications health. The development of synovitis is not a medical mistake; in 95% of cases, the disease progresses due to violation of medical prescriptions. If you have been diagnosed with synovitis, a fluid puncture and a course of further rehabilitation may be prescribed.

Inflammation

After surgery, the muscles or tissue around the endoprosthesis may become inflamed. In 4-11% of cases, infectious processes lead to revision of the implant. Most often, this phenomenon is observed in patients who have undergone arthroscopy due to rheumatoid arthritis or arthrosis.

In rare cases, the cause of infection is a violation sanitary standards in the operating room, the use of low-quality implant and suture material. Before choosing a clinic, be sure to read reviews from people who have had a replacement at this hospital.

Also, the development of the infectious process is provoked by malnutrition or excess weight, the presence of immune diseases, alcohol consumption, diabetes and oncology. Immunosuppressants and corticoids are contraindicated as treatment, as they increase the risk of infection. Signs of inflammation:

• stable elevated, but not too much heat body (rises more in the evening);
• the leg does not work well, it hurts and swells;
• local redness;
• sometimes discharge of pus from a wound or joint.

Inflammation is an unpredictable pathology, since it can occur both in the first months after arthroplasty and 1-2 years after knee replacement. If in the long-term postoperative period you have a question: “Why is the knee hot and painful?” — most likely, we are talking about a late hematogenous infection in the implant area.

Relieving pain, much less prescribing antibiotics, is strictly contraindicated. Only an orthopedic surgeon can prescribe antibiotics, prescribe pain relief and suggest which ointment to use after examination. Failure to comply with medical recommendations may result in revision knee replacement.

Repeated dislocation or fracture

Thanks to modern equipment, the implant is installed at the site of the damaged joint with millimeter precision, and kinematics are checked in a flexed/extended position using computer visualization. 1-1.2% of cases end with repeated dislocation or fracture of the endoprosthesis. In rare situations, the problem is caused by incorrect installation or poor-quality prosthesis; 98% of patients create a problem for themselves by ignoring rehabilitation recommendations.

The main sign of a fracture is a crunching sound inside the knee joint. And if at an early stage such a symptom can be explained by a medical error or a postoperative complication, then in the future the crunching indicates the growth of scar tissue. Incorrect recovery occurs due to non-compliance with the regime and diet.

When a crunch appears, don’t wait further complications. By contacting a specialist to correct defects, you can get by with therapeutic effects and avoid revision.

Knee replacement: complications and recommendations

Joint replacement surgery is not a whim, but an opportunity to maintain independence and avoid disability. Implantation is recommended if conservative methods It is impossible to restore the natural mobility of the limb. Surgical intervention is performed for:

• severe damage to the ligaments, when therapy and compression are not effective;
• osteoarthritis and rheumatoid arthritis, to stabilize the pathology and remove damaged elements;
• bone dysplasia, when bone growth is impaired;
• progressive aseptic necrosis. Tissue death begins, subsequently natural blood flow stops, and the joint ceases to function completely;
• gout.

To minimize operational and postoperative risks, the doctor performs a wide range of examinations. Only after eliminating all contraindications can a knee joint replacement with an implant be prescribed.

Modern doctors prefer gentle techniques; interventions on an open surgical field are carried out only if it is impossible to carry out the procedure in a minimally invasive way. With computer-guided arthroscopy, healthy tissue is practically not damaged, and the risk of bleeding and infection is reduced.

Measures after surgery

To remove excess fluid and blood clots from the wound, drainage is initially installed. Vital signs are taken daily during inpatient observation to make the recovery process as effective as possible.

If knee replacement is successful, a course of antibiotics and rehabilitation measures is prescribed:

• Exercise therapy under the supervision of a methodologist. You should not count on a miracle immediately after the operation; at first you will even have to bend and straighten your leg with the help of a doctor;
• massotherapy;
• procedures in the physiotherapy room depending on health conditions;

If recovery is going well, on day 2-3 you can start walking with a walker or crutches. According to patient reviews, a well-chosen rehabilitation scheme allows you to avoid complications and quickly return to your normal activities.

In order for rehabilitation to be effective and not protracted, a professional will advise how to change living conditions, adjust nutrition, and evenly distribute the load on the operated leg. If the outcome is successful, the sutures are removed on the 10th day; further home treatment under the supervision of a local doctor.

In addition to the main complications, the following problems may arise after joint replacement:

• presence of an allergic reaction;
• implant rejection;
• postoperative tissue decay;
• nerve damage, and, as a result, limb paralysis;
• vascular damage. As a result, a shortage of blood supply occurs. Without blood flow and nutritional ingredients, tissues become thinner. Ignoring the problem can lead to amputation;
• feeling of numbness in the knee;
• deep vein thrombosis;
• bacterial and infectious pathologies of the prosthesis.

An atypical reaction of the body to post-operative stress is bulimia. I constantly want to eat, but I don’t gain weight. In case of nervous disorder and bulimia, it is necessary to visit a psychologist to develop a stress relief program. Nervous disorders interfere with rapid rehabilitation, as does a failure in the regime.

Rehabilitation complex

Rehabilitation lower limb takes place in several stages:

The inpatient stage lasts the first two weeks after surgery (sometimes the patient is discharged home earlier after 4-6 days). All activities and procedures are carried out under control. To prevent thrombophlebitis, a compression bandage is worn, which limits mobility. The limb cannot be loaded for 1-3 days; the kinematics will be checked by the attending physician. The following is a recommended exercise:

• bending the knee from a supine position. Perform 10 approaches several times a day, but without overexertion;
• raising your legs from a prone position. A bolster or hard pillow is placed under the ankle. The goal is to lift your knees off the surface and hold the position for a few seconds;
• raising/lowering the straight sore leg;
• From a standing position, lift your limbs one by one at an angle of 45 degrees.

A month after knee replacement: “home” rehabilitation

The home environment is relaxing and this is its danger. In order for recovery to proceed correctly, there is no need to go to extremes; both inactivity and vigorous activity are equally harmful. By adhering to medical recommendations, you guarantee yourself not only successful rehabilitation, but also the safety of the endoprosthesis. The guaranteed service life of the artificial joint is 10 years, but under incorrect loads, the elements wear out faster.

Gymnastics for the first month:

According to current legislation, a certificate of incapacity is issued for 15 working days; if the work involves physical activity or being on your feet, it is better to go to the hospital at your place of residence to extend your sick leave. To make a decision, a special commission will be assembled, which, after familiarizing itself with the medical history, will issue a verdict - to extend the sick leave and for how long.

The maximum period for which the commission’s decision is valid is 10 months; if the certificate of incapacity for work needs to be extended for a year, another consultation is held. The walking time for each person may vary depending on the characteristics of the body; a trip to a sanatorium or hospitalization may be required to identify signs of implant instability. Failure to comply with recommended exercise therapy may be a reason for refusal to extend sick leave.

5 months after discharge, you can begin training on special simulators and return to an active lifestyle. If you continue to experience pain during this period, contact your podiatrist immediately. Most likely, the matter is in a pathological process.

Disability after knee replacement

Most people assume that joint replacement provides disability. This is wrong. Implantation, on the contrary, guarantees the restoration of normal mobility, which disabled person can return to active life in six months, forgetting about pain. The postoperative group is awarded only if arthroscopy is ineffective and the disease progresses:

• deforming arthrosis of at least stage 2;
• arthrosis with leg deformity (curvature, shortening);
• prosthetics articular segments on both limbs with unforeseen consequences or abnormalities.

Important! A person agrees to undergo endoprosthetics in an effort to maintain independence, therefore, with a normally performed operation and without significant impairment of musculoskeletal functions, disability is not assigned!

To prevent the development of pathologies, the patient constantly wears compression stockings for the first 3 weeks after implantation. The level of compression is determined by the attending physician based on the results of the examination. Also, how effective the early stage of rehabilitation will be depends on the choice of crutches. Good handy tools with support under the elbow reduce the load on the sore leg, ensuring peace and proper blood flow.

The doctor decides which crutches are best. The patient's height and weight are taken into account anatomical features. In the absence of painful sensations, the axial load gradually increases, and then a cane is used.

Exercising on exercise equipment, swimming, walks in the fresh air and a balanced diet are the key to successful treatment. Listen to the state of your body, do not hesitate to bother the doctor, then you will not need an audit for many years.

Possible consequences of hip replacement

Endoprosthetics hip joint is an operation to replace the affected joint with an endoprosthesis. Just like after any other surgical intervention, complications may arise. 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.
• History of previous surgery or infectious diseases of the 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 over a long period of time with 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.

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 occur: 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.

Content

An operation to restore the functionality of the lower limb is necessary to improve the patient’s quality of life - this is hip replacement. It is one of the largest and most heavily loaded. If the hip joint is ineffective, a person cannot even stand on his feet. You have to completely forget about sports and dancing. How hip replacement surgery is performed, preparation for it, types and rehabilitation are discussed below.

What is hip replacement

A complex surgical operation that requires replacing worn or destroyed parts of the largest bone joint in the body, the hip joint (HJ), with artificial parts is arthroplasty. The “old” hip joint is replaced with an endoprosthesis. It is called so because it is installed and located inside the body (“endo-”). The product is subject to requirements for strength, reliable fixation of components and biocompatibility with tissues and structures of the body.

The artificial “joint” bears more load due to the absence of friction-reducing cartilage and synovial fluid. For this reason, dentures are made from high-quality metal alloys. They are the most durable and last up to 20 years. Polymers and ceramics are also used. Several materials are often combined in one endoprosthesis, for example, plastic and metal. In general, the formation of an artificial hip joint is ensured by:

• prosthetic cups replacing the acetabulum of the joint;
• a polyethylene liner that reduces friction;
• a head that provides soft gliding during movements;
• legs, which absorb the main loads and replace the upper third of the bone and the femoral neck.

Who needs it

Indications for endoprosthetics are serious damage to the structure and functional disorders of the hip joint, which lead to pain while walking or any other motor activity. This may be due to injuries or previous bone diseases. Surgery is also necessary if there is stiffness of the hip joint or a significant decrease in its volume. Specific indications for endoprosthetics include:

• malignant tumors of the femoral neck or head;
• coxarthrosis grade 2-3;
• femoral neck fracture;
• hip dysplasia;
• post-traumatic arthrosis;
• aseptic necrosis;
• osteoporosis;
• osteoarthritis;
• Perthes disease;
• rheumatoid arthritis;
• formation of a false hip joint, more often in older people.

Contraindications

Not all people who need hip replacement surgery can undergo hip surgery. Contraindications to it are divided into absolute, when surgical intervention is prohibited, and relative, i.e. it is possible, but with caution and under certain conditions. The latter include:

• oncological diseases;
• hormonal osteopathy;
• 3 degree of obesity;
• liver failure;
• chronic somatic pathology.

Absolute contraindications include more diseases and pathologies. Their list includes:

• foci of chronic infection;
• absence of a bone marrow canal in the femur;
• thromboembolism and thrombophlebitis;
• paresis or paralysis of the leg;
• skeletal immaturity;
• chronic cardiovascular failure, arrhythmia, heart disease;
• cerebrovascular accident;
• inability to move independently;
• bronchopulmonary diseases with respiratory failure, such as emphysema, asthma, pneumosclerosis, bronchiectasis;
• recent sepsis;
• multiple allergies;
• inflammation of the hip joint associated with damage to muscles, bones or skin;
• severe osteoporosis and low strength bone tissue.

Types of hip replacements

In addition to classification by materials, hip joint endoprostheses are divided according to several other criteria. One of them is based on the components of the prosthesis. He can be:

1. Single pole. In this case, the prosthesis consists only of a head and a stem. They replace the corresponding parts of the hip joint. Only the acetabulum remains “native”. Today such a prosthesis is rarely used. The reason is that there is a high risk of destruction of the acetabulum.
2. Bipolar, or total. This type The prosthesis replaces all parts of the hip joint - neck, head, acetabulum. It is better fixed and maximally adapted to the body. This increases the success of the operation. The total denture is suitable for older people and young people with high activity levels.

Endoprosthesis service life

The number of years that an endoprosthesis can last depends on the materials used in its manufacture. The strongest ones are metal ones. They last up to 20 years, but are characterized by less functional results in relation to the motor activity of the operated limb. Plastic and ceramic prostheses boast a shorter service life. They can only serve for 15 years.

Types of endoprosthetics operations

Depending on the prostheses used, endoprosthetics can be total or partial. In the first case, the head, neck and acetabulum of the articulation are replaced, in the second - only the first two parts. Another classification of the operation uses the method of fixation of the endoprosthesis as a criterion. Ceramics or metal must be firmly connected to the bones so that the hip joint can function fully. After selecting the endoprosthesis and its size, the doctor determines the type of fixation:

1. Cementless. The implant is fixed in place at the hip joint due to its special design. The surface of the prosthesis has many small projections, holes and depressions. Over time, bone tissue grows through them, thus forming an integral system. This method increases the recovery time.
2. Cement. It involves attaching the endoprosthesis to the bone using a special biological glue called cement. It is prepared during the operation. Fixation occurs due to the hardening of cement. In this case, restoration of the hip joint is faster, but there is a high risk of implant rejection.
3. Mixed or hybrid. It consists of a combination of both methods - cement and cementless. The stem is secured with glue, and the cup is screwed into the acetabulum. It is considered the most optimal way to fix the prosthesis.

Preparing for surgery

The first step before surgery is to have your feet examined by a doctor. As diagnostic procedures X-rays, ultrasound and MRI of the operated area are used. The patient is hospitalized two days before the scheduled operation for a series of other procedures that will help eliminate the presence of contraindications. Conducted:

• blood clotting test;
• OAM and UAC;
• determination of blood group and Rh factor;
• biochemical blood test;
• tests for syphilis, hepatitis, HIV;
• consultations with more specialized specialists.

Next, the patient is provided with information about possible complications, offer to sign consent for surgical intervention. At the same time, instructions are given about behavior during and after the operation. Only a light dinner is allowed the day before. In the morning you can no longer drink or eat. Before the operation, the skin in the thigh area is shaved, and the legs are wrapped with elastic bandages or compression stockings are put on them.

Progress of the operation

After transporting the patient to the operating room, I give him anesthesia - full anesthesia with controlled breathing or spinal anesthesia, which is less harmful and is therefore more often used. The hip replacement technique is as follows:

• after anesthesia, the doctor treats the surgical field with antiseptics;
• then he cuts through the skin and muscle, making an incision of about 20 cm;
• then the intra-articular capsule is opened and the femoral head is removed into the wound;
• Next comes its resection until the medullary canal is exposed;
• the bone is modeled taking into account the shape of the prosthesis, and it is fixed using the selected method;
• Using a drill, he processes the acetabulum to remove cartilage from it;
• the cup of the prosthesis is installed into the resulting funnel;
• after installation, all that remains is to match the prosthetic surfaces and strengthen them by suturing the incised wound;
• A drain is inserted into the wound and a bandage is applied.

Temperature after hip replacement

An increase in temperature may be observed for 2-3 weeks after surgery. This is considered normal. In most cases, the body tolerates elevated temperatures well. Only if your condition is very bad, you can take an antipyretic tablet. You should only tell your doctor if your temperature rises after a period of several weeks when it was normal.

Rehabilitation

Hip replacement surgery requires the start of rehabilitation within the first hours after its completion. Rehabilitation measures include physical therapy, breathing exercises and early activation in general. The leg should be at functional rest, but movement is simply necessary. You can’t get up only on the first day. Changing the position of the body in bed and performing slight bends in the knee joint may be allowed by the doctor. In the following days, the patient can begin to walk, but with crutches.

How long does it last

Rehabilitation within the clinic lasts about 2-3 weeks. At this time, the doctor monitors the wound healing process. Postoperative sutures are removed approximately 9-12 days. The drainage is removed as the discharge decreases and completely stops. For approximately 3 months, the patient must use walking support. Full walking is possible after 4-6 months. Rehabilitation after hip replacement lasts approximately this long.

Life after hip replacement

If a person is somatically healthy and has no concomitant diseases, then he is able to restore the functionality of his leg almost completely. The patient can not only walk, but also play sports. You cannot perform only exercises related to strength tension of the limbs. Complications after endoprosthetics are more common in older people or when the postoperative regimen is not followed.

Disability after endoprosthetics

Not all cases of hip replacement result in disability. If the patient is suffering from pain and cannot perform his work normally, then he can apply for registration. Recognition of a person as disabled is carried out on the basis of a medical and social examination. To do this, you need to go to the clinic at your place of residence and go through all the necessary specialists.

The basis for disability is often not the endoprosthetics itself, but the diseases that required the operation. Experts consider the severity of impaired motor functions. If, after surgery, reduced functionality in the hip joint remains, the patient is given disability group 2-3 for 1 year with the possibility of subsequent re-registration.

Cost of the operation

Almost all patients are interested in the question of how much a hip replacement costs. There are several programs by which this operation can be performed:

• free under the compulsory medical insurance policy (in this case, you may face a queue for 6-12 months in advance);
• paid in a private or public clinic;
• free under high-tech quota medical care(here circumstances are required to provide benefits).

In addition to the price of the operation itself, the cost of the hip joint prosthesis is also important. It depends on the reason that led to the need for endoprosthetics. In case of coxarthrosis, the cost of the prosthesis will be higher than in case of a femoral neck fracture. The approximate cost of surgery to replace the hip joint and prosthesis is shown in the table:

Video

You can find expert opinion on hip replacement, as well as patient reviews, on the website.

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and make treatment recommendations based on individual characteristics specific patient.

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Hello. I had hip replacement surgery, 4 months have passed. The temperature remains at 37.6, they did a series of blood tests (everything is fine), there was a blood accumulation of 2 ml - they pumped it out, constant pain in the joint area, x-ray is normal. Tell me how long the fever and pain will last. Thank you

Hello. If such a temperature is without pain and without an X-ray/ultrasound picture of inflammation, instability, etc., then this sometimes occurs and does not necessarily indicate something bad (although it is better that there is no temperature). But if there is pain, then you need to be examined very carefully, incl. and in dynamics to exclude instability of components and/or suppuration. This cannot be done over the Internet. I recommend going to specialized departments that deal primarily with endoprosthetics or bone-purulent infections, or better yet, go to both at once and go through full examination- X-rays, ultrasound, tests, sometimes CT, sometimes punctures with bacterial culture, etc.

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The intensive development of hip arthroplasty, along with the high rehabilitation potential of this operation, is accompanied by an increase in the number of cases of deep infection in the surgical area, amounting, according to domestic and foreign authors, from 0.3% to 1% in primary arthroplasty, and 40% and more - during revision. Treatment of infectious complications after this type of operation is a long process, requiring the use of expensive medications and materials.

Treatment issues for patients who have developed infectious process after hip replacement, continue to be a hot topic for discussion among specialists. It was once considered completely unacceptable to implant an endoprosthesis into an infected area. However, evolving understanding of the pathophysiology of implant-associated infection, as well as advances in surgical technique, have made successful arthroplasty possible in this setting.

Most surgeons agree that removal of endoprosthetic components and careful debridement of the wound are an important initial stage of patient treatment. However, regarding techniques that can restore functional state joint without pain and with minimal risk of recurrent infection, there is still no consensus.

Classification

Using an effective classification system is important when comparing treatment results and determining the most appropriate treatment option.

With all the variety of proposed classification systems, the absence of an international system of criteria for constructing a diagnosis and subsequent treatment of paraendoprosthetic infection indicates that the treatment of infectious complications after endoprosthetics is rather poorly standardized.

The most common classification of deep infection after total hip arthroplasty according to M.V. Coventry - R.H, Fitzgerald, the main criterion of which is the time of manifestation of the infection (the time interval between the operation and the first manifestation of the infectious process). Based on this criterion, the authors identified three main clinical types of deep infection. In 1996, D.T. Tsukayama et al added type IV to this classification, defined as a positive intraoperative culture. This type of paraendoprosthetic infection refers to asymptomatic bacterial colonization of the surface of the endoprosthesis, which manifests itself in the form of positive intraoperative cultures of two or more samples with isolation of the same pathogenic organism.

Classification of deep infection after total hip arthroplasty (Coventry-Fitzgerald-Tsukayama)

	Type of infection	Manifestation time
I	Acute postoperative	During the first month
II	Late chronic	From one month to a year
III	Acute hematogenous	After a year or more
IV	Positive intraoperative culture	Positive cultures of 2-5 intraoperative samples

Depending on the type of infection, the authors recommended certain treatment tactics. Thus, in type I infection, revision with necrectomy, replacement of the polyethylene liner and preservation of the remaining components of the endoprosthesis is considered justified. The authors believe that in case of type II infection, during a revision with mandatory necrosectomy, removal of the endoprosthesis is required, and in patients with type III paraendoprosthetic infection, an attempt can be made to preserve it. In turn, if a positive intraoperative culture is diagnosed, treatment can be conservative: suppressive parenteral antibiotic therapy for six weeks.

Features of the pathogenesis of paraendoprosthetic infection

Paraendoprosthetic infection is a special case of implant-associated infection and, regardless of the route of entry of the pathogen, the time of development and the severity of clinical manifestations, it is specific to endoprosthetics. In this case, the leading role in the development of the infectious process is given to microorganisms and their ability to colonize biogenic and abiogenic surfaces.

Microorganisms can exist in several phenotypic states: adherent - biofilm form of bacteria (biofilm), free-living - planktonic form (in solution in suspension), latent - spore.

The basis of the pathogenicity of microbes that cause paraendoprosthetic infections is their ability to form special biofilms (biofilms) on the surfaces of implants. Understanding this fact is extremely important for determining rational treatment tactics.

There are two alternative mechanisms for bacterial colonization of the implant. The first is through direct nonspecific interaction between the bacterium and an artificial surface not covered with host proteins due to the forces of the electrostatic field, surface tension forces, Waan der Wiels forces, hydrophobicity and hydrogen bonds. It has been shown that there is selective adhesion of microbes to the implant depending on the material from which it is made. Adhesion of St. strains epidermidis occurs better in the polymer parts of the endoprosthesis, and strains of St. aureus - to metal.

In the second mechanism, the material from which the implant is made is coated with host proteins, which act as receptors and ligands that bind the foreign body and microorganism together. It should be noted that all implants undergo so-called physiological changes, as a result of which the implant is almost instantly coated with plasma proteins, mainly albumin.

After the adhesion of bacteria and the formation of a monolayer, the formation of microcolonies occurs, enclosed in an extracellular polysaccharide matrix (EPM) or glycocalyx (EPM is created by the bacteria themselves). Thus, a bacterial biofilm is formed. EPM protects bacteria from the immune system, stimulates monocytes to create prostaglandin E, which suppresses T-lymphocyte proliferation, B-lymphocyte blastogenesis, immunoglobulin production and chemotaxis. Studies of bacterial biofilms show that they have a complex three-dimensional structure, much like the organization of a multicellular organism. In this case, the main structural unit of the biofilm is a microcolony consisting of bacterial cells (15%) enclosed in an EPM (85%).

During the formation of a biofilm, adhesion of aerobic microorganisms first occurs, and as it matures, conditions are created in the deep layers for the development of anaerobic microorganisms. Periodically, when reaching a certain size or under the influence external forces, individual fragments of the biofilm are torn off with their subsequent dissemination to other places.

In the light of new knowledge about the pathogenesis of implant-associated infection, the high resistance of adherent bacteria to antibacterial drugs, the futility of conservative tactics, as well as revision interventions with preservation of the endoprosthesis in patients with type II-III paraendoprosthetic infection.

Diagnosis of paraendoprosthetic infection

Identification of any infectious process involves the interpretation of a set of procedures, including clinical, laboratory and instrumental studies.

Diagnosis of paraendoprosthetic infection is not difficult if classic clinical symptoms inflammation (limited swelling, local pain, local fever, hyperemia skin, dysfunction) in combination with a systemic inflammatory response syndrome, characterized by the presence of at least two of four clinical signs: temperature above 38°C or below 36°C; heart rate over 90 beats per minute; respiratory rate over 20 breaths per minute; the number of leukocytes is above 12x10 or below 4x10, or the number of immature forms exceeds 10%.

However, significant changes in the immunobiological reactivity of the population, caused by both the allergenic influence of many environmental factors and the widespread use of various therapeutic and preventive measures (vaccines, blood transfusions and blood substitutes, medications, etc.), have led to the fact that blurred clinical picture of the infectious process, making timely diagnosis difficult.

From a practical point of view, for the diagnosis of paraendoprosthetic infection, it seems most rational to use standard definitions cases of surgical site infection (SSI), developed in the USA by the Centers for Disease Control and Prevention (CDC) for the National Nosocomial Infection Surveillance (NNIS) program. The CDC criteria are not only the de facto national standard in the United States, but are also used virtually unchanged in many countries around the world, providing, in particular, the possibility of comparing data at the international level.

Based on these criteria, SSIs are divided into two groups: infections of the surgical incision (surgical wound) and infections of the organ/cavity. Incision SSIs, in turn, are divided into superficial (only the skin and subcutaneous tissues are involved in the pathological process) and deep infections.

Criteria for superficial SSI

Infection occurs up to 30 days after surgery and is localized within the skin and subcutaneous tissues in the incision area. The criterion for diagnosis is at least one of the following signs:

1. purulent discharge from a superficial incision with or without laboratory confirmation;
2. isolation of microorganisms from fluid or tissue obtained aseptically from the area of ​​a superficial incision;
3. presence of symptoms of infection: pain or tenderness, limited swelling, redness, local fever, unless culture from the wound gives negative results.
4. The diagnosis of superficial incision SSI was made by a surgeon or other attending physician.

Suture abscess is not registered as an SSI (minimal inflammation or discharge limited to points of penetration of the suture material).

Criteria for deep SSI

Infection occurs up to 30 days after surgery if there is no implant or no later than one year if there is one. There is reason to believe that the infection is associated with this surgical procedure and is localized in the deep soft tissues (for example, fascial and muscle layers) in the incision area. The criterion for diagnosis is at least one of the following signs:

1. purulent discharge from the depth of the incision, but not from the organ/cavity in the surgical area;
2. spontaneous wound dehiscence or intentional opening by the surgeon with the following signs: fever (> 37.5°C), localized tenderness, unless wound culture is negative;
3. on direct examination, during reoperation, on histopathological or x-ray examination an abscess or other signs of infection are found in the area of ​​the deep incision;
4. The diagnosis of deep incision SSI was made by a surgeon or other attending physician.

Infection involving both deep and superficial incisions is reported as deep incision SSI.

Laboratory research

Leukocyte count in peripheral blood

Increase in the number of neutrophils during manual counting individual species leukocytes, especially when a shift in the leukocyte formula to the left and lymphocytopenia is detected, means the presence of an infectious infection. However, when chronic course paraendoprosthetic infection, this form of diagnosis is uninformative and does not have much practical significance. The sensitivity of this parameter is 20%, specificity is 96%. At the same time, the level of predictability of positive results is 50%, and of negative ones - 85%.

Erythrocyte sedimentation rate (ESR)

The ESR test is a measurement of the physiological response of red blood cells to agglutination when stimulated by protein reagents in the acute phase. Typically, this method is used in orthopedics when diagnosing an infectious lesion and subsequently monitoring it. Previously, an ESR value of 35 mm/hour was used as a differential threshold criterion between aseptic and septic loosening of the endoprosthesis, with a sensitivity of 98% and a specificity of 82%.

It should be taken into account that other factors may also influence an increase in ESR levels (concomitant infectious diseases, collagen vascular lesions, anemia, recent surgery, a number of certain malignant diseases, etc.). Therefore, a normal ESR level can be used as evidence of the absence of an infectious lesion, while its increase is not an accurate indicator of excluding the presence of infection.

However, the ESR test may also be useful in determining chronic infection after repeat arthroplasty. If the ESR level is more than 30 mm/hour six months after a two-stage procedure to replace a total endoprosthesis, the presence of a chronic infection can be assumed with an accuracy of 62%.

C-reactive protein(SRB)

CRP belongs to the acute phase proteins and is present in the blood serum of patients with injuries and diseases of the musculoskeletal system, which are accompanied by acute inflammation, destruction and necrosis, and is not a specific test for patients who have undergone joint replacement. As a screening test for a patient who has developed a peri-endoprosthetic infection, the CRP test is a very valuable tool, since it is not technically difficult and does not require large financial costs. The level of CRP decreases soon after the infectious process is stopped, which, in turn, does not occur with ESR. Increased level The ESR may remain for a year after successful surgery before returning to normal. normal level, while the CRP level returns to normal within three weeks after the operation. According to various authors, the sensitivity of this indicator reaches 96%, and the specificity - 92%.

Microbiological studies

Bacteriological research includes identification of the pathogen (qualitative composition of the microflora), determination of its sensitivity to antibacterial drugs, as well as quantitative characteristics (number of microbial bodies in tissues or wound contents).

Valuable diagnostic procedure A method that allows you to quickly get an idea of ​​the probable ethology of the infectious process is microscopy with Gram staining of the resulting material. This study is characterized by low sensitivity (about 19%), but fairly high specificity (about 98%). Wound discharge in the presence of fistulas and wound defects, contents obtained during joint aspiration, tissue samples surrounding the endoprosthesis, and prosthetic material are subject to study. The success of isolating a pure culture largely depends on the order of collection, transportation, inoculation of the material on nutrient media, as well as on the type of infectious process. In patients whose surgical treatment included implants, microbiological testing provides a low degree of infection detection. The main material for research is discharge from wound defects, fistulas and contents obtained during joint aspiration. Since in implant-associated infections the bacteria are predominantly in the form of adhesive biofilms, they are extremely difficult to detect in the synovial fluid.

In addition to standard bacteriological examination of tissue culture samples, modern methods of analysis at the molecular biological level have been developed. Thus, the use of polymerase chain reaction (PCR) will determine the presence of bacterial deoxyribonucleic acid or ribonucleic acid in tissues. A culture sample is placed in a special environment in which it undergoes a development cycle for the purpose of exposure and polymerization of deoxyribonucleic acid chains (consecutive passage of 30 - 40 cycles is required). By comparing the obtained deoxyribonucleic acid sequences with a number of standard sequences, the microorganism that caused the infectious process can be identified. Although the PCR method has high sensitivity, it has little specificity. This explains the possibility of obtaining false-positive responses and the difficulty in differentiating a stopped infectious process from a clinically active infection.

Instrumental studies

X-ray diffraction

There are very few specific radiological signs that can be used to identify an infection, and none of them are pathognomonic for periprosthetic infection. There are two radiological signs that, although they do not make it possible to diagnose the presence of an infectious process, do suggest its existence: periosteal reaction and osteolysis. The rapid appearance of these signs after a successful operation, in the absence of visible reasons for this, should increase suspicions about a possible infectious lesion. In this case, X-ray control is mandatory, since only by comparison with previous radiographs of good quality can one judge the real state of affairs.

In case of fistulous forms of paraendoprosthetic infection, a mandatory research method is x-ray fistulography, which makes it possible to clarify the location of the fistulous tracts, the localization of purulent leaks and their connection with foci of destruction in the bones. Based on contrast X-ray fistulography, differential diagnosis of superficial and deep forms of paraendoprosthetic infection can be carried out.

X-ray fistulography of the left hip joint and left thigh of patient P., 39 years old.
Diagnosis: paraendoprosthetic infection type III; fistula in the lower third of the thigh, the postoperative scar is intact, without signs of inflammation.

Magnetic resonance examination

Magnetic resonance imaging studies are regarded as additional and are used when examining patients with paraendoprosthetic infection, usually for the purpose of diagnosing intrapelvic abscesses, clarifying their size and extent of spread within the pelvis. The results of such studies help with preoperative planning and increase hopes for a favorable outcome during repeated replacement of the endoprosthesis.

Radioisotope scanning

Radioisotope scanning using various radiopharmaceuticals (Tc-99m, In-111, Ga-67) is characterized by low information content, high cost and labor-intensive research. Currently, it does not play an important role in diagnosing an infectious process in the area of ​​the operated joint.

Ultrasound echography (ultrasound)

Ultrasound is effective as a screening method, especially in cases where infection is highly likely and conventional femoral aspiration is negative. In such situations, ultrasound helps to determine the location of the infected hematoma or abscess and, upon repeated puncture, obtain the necessary samples of the pathological contents.

Ultrasound of the right hip joint, patient B., 81 years old.
Diagnosis: paraendoprosthetic infection type II. Ultrasound signs of moderate effusion in the projection of the neck of the right hip joint, limited by the pseudocapsule, V up to 23 cm 3

Aortoangcography

This study is complementary, but can be extremely important in preoperative planning in patients with defects of the acetabular floor and migration of the acetabular component of the endoprosthesis into the pelvic cavity. The results of such studies help to avoid serious complications during surgery.

Aortography of patient 3., 79 years old.
Diagnosis: paraendoprosthetic infection type III; instability, separation of the components of the total endoprosthesis of the left hip joint, defect of the floor of the acetabulum, migration of the acetabular component of the endoprosthesis into the pelvic cavity.

General principles treatment of patients with paraendoprosthetic infection

Surgical treatment of patients with paraendoprosthetic infection generally reflects advances in the field of endoprosthetics.

In the past, treatment tactics were largely the same for all patients and largely depended on the surgeon's point of view and experience.

However, today there is a fairly wide choice of treatment options that take into account the general condition of the patient, the reaction of his body to the development of the pathological process, the time of manifestation of the infection, the stability of fixation of the components of the endoprosthesis, the prevalence of the infectious lesion, the nature of the microbial pathogen, its sensitivity to antimicrobial drugs, the condition of the bones and soft tissues in the area of ​​the operated joint.

Surgical treatment options for paraendoprosthetic infection

When determining surgical tactics in the case of an established fact of paraendoprosthetic infection, the main thing is to decide on the possibility of preserving or reinstalling the endoprosthesis. From this position, it is advisable to distinguish four main groups of surgical interventions:

• I - revision with preservation of the endoprosthesis;
• II - with one-stage, two-stage or three-stage endoprosthetics.
• III - other procedures: revision with removal of the endoprosthesis and resection arthroplasty; with removal of the endoprosthesis and the use of VCT; removal of the endoprosthesis and non-free musculoskeletal or muscle plastic surgery.
• IV - disarticulation.

Technique for revision of the artificial hip joint area

Regardless of the timing of the development of infection after hip replacement, when deciding on surgical treatment, it is necessary to adhere to the following principles of revision of the area of ​​the artificial hip joint: optimal access, visual assessment pathological changes in soft tissues and bone, revision of the components of the endoprosthesis (which cannot be fully performed without dislocating the artificial joint), determination of indications for maintaining or removing components or the entire endoprosthesis, methods for removing bone cement, drainage and closure of the surgical wound.

Access is through the old postoperative scar. First, a dye (an alcohol solution of brilliant green in combination with hydrogen peroxide) is injected into the fistula (or wound defect) using a catheter connected to a syringe. In cases where there are no fistulas, it is possible to inject a dye solution during puncture of a purulent focus. After injection of the dye, passive movements are performed in the hip joint, which improves staining of the tissue deep in the wound.

The wound is inspected, focusing on the spread of the dye solution. Visual assessment of soft tissues includes studying the severity of swelling of the latter, changes in their color and consistency, the absence or presence of soft tissue detachment and its extent. The nature, color, smell and volume of liquid pathological contents of the surgical wound are assessed. Samples of pathological contents are taken for bacteriological examination.

If the cause of suppuration is ligatures, the latter are excised along with the surrounding tissues. In these cases (in the absence of dye flow into the area of ​​the artificial joint), revision of the endoprosthesis is not advisable.

For isolated epifascial hematomas and abscesses, after evacuation of blood or pus and excision of the edges of the wound, a puncture of the area of ​​the artificial hip joint is performed in order to exclude non-draining hematomas or reactive inflammatory exudate. If they are detected, a full inspection of the wound is carried out to its full depth.

After exposure of the endoprosthesis, the stability of the artificial joint components is assessed. The stability of the acetabular component and polyethylene liner is assessed using compression, traction and rotation forces. The strength of the component's fit in the acetabulum is determined by the pressure on the edge of the metal frame of the prosthesis cup. In the absence of mobility of the cup and (or) release of fluid (dye solution, pus) from under it, the acetabular component of the prosthesis is considered stable.

The next step is to dislocate the head of the endoprosthesis, and determine the stability of the femoral component by applying strong pressure on it from different sides, while performing rotational and traction movements. In the absence of pathological mobility of the endoprosthesis leg, or the release of fluid (dye solution, pus) from the medullary space of the femur, the component is considered stable.

After monitoring the stability of the endoprosthesis components, a re-examination of the wound is carried out in order to identify possible purulent leaks, an assessment of the condition of the bone structures, a thorough necrectomy, excision of the edges of the surgical wound with re-treatment of the wound with antiseptic solutions and mandatory vacuuming. The next stage involves replacing the polyethylene liner, repositioning the head of the endoprosthesis and re-treating the wound with antiseptic solutions with mandatory vacuuming.

Wound drainage is carried out in accordance with the depth, localization and extent of the infectious process, as well as taking into account possible paths of spread of pathological contents. For drainage, perforated polyvinyl chloride tubes of various diameters are used. The free ends of the drains are removed through separate punctures of the soft tissues and fixed to the skin with separate interrupted sutures. An aseptic bandage with an antiseptic solution is applied to the wound.

Revision with preservation of endoprosthesis components

Postoperative hematoma plays a large role in the development of early local infectious complications. Bleeding of soft tissues and exposed bone surface in the first 1 - 2 days after surgery is observed in all patients. The incidence of hematomas after total arthroplasty is, according to various authors, from 0.8 to 4.1%. Such significant fluctuations are explained, first of all, by differences in attitudes towards this complication and underestimation of its danger. K.W. Zilkens et al believe that about 20% of hematomas become infected. The main method of preventing hematomas is careful handling of tissues, careful suturing and adequate drainage of the postoperative wound, and effective hemostasis.

Patients with an infected postoperative hematoma or late hematogenous infection are traditionally treated with open debridement and prosthesis retention and parenteral antimicrobial therapy without removal of endoprosthetic components.

According to various authors, the degree of success from this type of surgical intervention varies from 35 to 70%, with favorable outcomes in most cases observed during the revision on average within the first 7 days, and unfavorable ones - 23 days.

Performing a revision while preserving the endoprosthesis is justified in case of type I paraendoprosthetic infection. Patients for whom this treatment method is indicated must meet the following criteria: 1) the manifestation of infection should not exceed 14 - 28 days; 2) absence of signs of sepsis; 3) limited local manifestations of infection (infected hematoma); 4) stable fixation of endoprosthesis components; 5) established etiological diagnosis; 6) highly sensitive microbial flora; 7) the possibility of long-term antimicrobial therapy.

Treatment tactics when performing a revision while preserving the components of the endoprosthesis

Revision:

• replacement of the polyethylene liner, endoprosthesis head.

Parenteral antibacterial therapy: 3-week course (inpatient).

Suppressive oral antibiotic therapy: 4-6 week course (outpatient).

Control: clinical blood test, C-reactive protein, fibrinogen - at least once a month during the first year after surgery, subsequently - as indicated.

Clinical example. Patient S., 64 years old. Diagnosis: right-sided coxarthrosis. Condition after total endoprosthesis of the right hip joint in 1998. Aseptic instability of the acetabular component of the total endoprosthesis of the right hip joint. In 2004, re-endoprosthetics of the right hip joint was performed (replacement of the acetabular component). Removal of drainages - on the second day after surgery. Spontaneous evacuation of a hematoma was noted from the wound defect at the site of removed drainage in the area of ​​the right thigh. Based on the results of a bacteriological study of the discharge, an increase in Staphylococcus aureus with a wide spectrum of sensitivity to antibacterial drugs. Diagnosis: type I paraendoprosthetic infection. The patient underwent revision, sanitation, and drainage of the infectious focus in the area of ​​the right hip joint and right thigh, preserving the components of the endoprosthesis. Within 3 years after the revision, no recurrence of the infectious process was noted.

Reasons for unsatisfactory outcomes of revisions with preservation of the endoprosthesis:

• absence of early radical complex treatment suppurating postoperative hematomas;
• refusal to dislocate the endoprosthesis during revision;
• refusal to replace polyethylene inserts (replacement of the endoprosthesis head);
• audit for an unidentified microbial agent;
• preservation of the endoprosthesis in case of widespread purulent process in the tissues;
• an attempt to preserve the endoprosthesis during repeated revision in case of recurrence of the infectious process;
• refusal to carry out suppressive antibiotic therapy in the postoperative period.

Although there has been some success in recent years in treating patients with peri-endoprosthetic infection by debridement without removal of the endoprosthesis, the general consensus is that this method is ineffective, especially in the treatment of patients with type III paraendoprosthetic infection, and leads to a favorable outcome only under a certain set of conditions.

Revision with one-stage re-endoprosthetics

In 1970 H.W. Buchholz proposed a new treatment for periprosthetic infection: a one-stage prosthetic replacement procedure using antibiotic-loaded polymethyl methacrylate bone cement. In 1981, he published his data on the results of primary re-endoprosthesis on the example of 583 patients with this type of pathology. The success rate for this procedure was 77%. However, a number of researchers advocate a more cautious use of this treatment method, citing data on recurrence of the infectious process in 42% of cases.

General criteria for the possibility of performing one-stage revision arthroplasty:

absence of general manifestations of intoxication; limited local manifestations of infection;

a sufficient amount of healthy bone tissue;

established etiological diagnosis; highly sensitive gram-positive microbial flora;

the possibility of suppressive antimicrobial therapy;

both stability and instability of endoprosthetic components.

Clinical example.

Patient M, 23 years old, diagnosed with juvenile rheumatoid arthritis, activity I, viscero-articular form; bilateral coxarthrosis; pain syndrome; combined contracture. In 2004, surgical intervention was performed: total endoprosthetics of the right hip joint, spinotomy, adductorotomy. In the postoperative period, fibril fever was noted, laboratory tests showed moderate leukocytosis, and ESR was 50 mm/h. A bacteriological examination of a puncture from the right hip joint revealed the growth of Escherichia coli. The patient was transferred to the purulent surgery department with a diagnosis of paraendoprosthetic infection) type. The patient underwent revision, sanitation, drainage of the infectious focus in the area of ​​the right hip joint, and re-endoprosthetics of the right hip joint. Over the period of 1 year and 6 months after the revision, no recurrence of the infectious process was noted; total endoprosthetics of the left hip joint was performed.

Undoubtedly, one-stage replacement of an endoprosthesis is attractive, as it can potentially reduce patient morbidity, reduce the cost of treatment, and avoid technical difficulties during reoperation. Currently, one-stage repeated replacement of the endoprosthesis plays a limited role in the treatment of patients with paraendoprosthetic infection and is used only in the presence of a number of certain conditions. This type of treatment can be used to treat older patients who need a quick cure and who cannot tolerate a second surgery if re-implantation is performed in two stages.

Revision with two-stage re-endoprosthetics

Two-stage revision arthroplasty, according to most surgeons, is the preferred form of treatment for patients with paraendoprosthetic infection. The probability of a successful outcome when using this technique varies from 60 to 95%.

A two-stage revision includes removal of the endoprosthesis, careful surgical debridement of the infection, then an interim period with a course of suppressive antibiotic therapy for 2-8 weeks and installation of a new endoprosthesis during a second operation.

One of the most difficult moments when performing a two-stage endoprosthesis replacement is the exact choice of when to perform the second stage. Ideally, joint reconstruction should not be performed in the presence of an unresolved infectious process. However, most of the data used to determine the optimal duration of the staging phase is empirical. The duration of stage II ranges from 4 weeks to one or more years. Therefore, when making a decision, a clinical assessment of the course of the postoperative period plays a significant role.

If peripheral blood tests (ESR, CRP, fibrinogen) are performed monthly, their results can be very useful in determining the timing of final surgery. If postoperative wound healed without any signs of inflammation, and the above indicators returned to normal during the intermediate stage of treatment, it is necessary to carry out a second stage of surgical treatment.

At the final stage of the first operation, it is possible to use various types of spacers using bone cement impregnated with antibiotics (ALBC-Artibiotic-Loadet Bone Cement).

The following spacer models are currently used:

• Block-shaped spacers, made entirely of ALBC, serve mainly to fill the dead space in the acetabulum;
• medullary spacers, which are a monolithic ALBC rod inserted into the medullary canal of the femur;
• articulated spacers (PROSTALAC), which exactly follow the shape of the endoprosthesis components, are made of ALBC.

The main disadvantage of the trochlear and medullary spacers is the proximal displacement of the femur.

X-ray of the right hip joint of patient P., 48 years old. Diagnosis: paraendoprosthetic infection type I, deep form, recurrent course. Condition after installation of a combined trochlear-medullary spacer. Proximal femoral displacement.

A pre-selected new femoral component of the endoprosthesis or a recently removed one can be used as a spacer. The latter undergoes sterilization during the operation. The acetabular component is specially manufactured from ALBC.

Options for articulated spacers.

General criteria for the possibility of performing two-stage revision arthroplasty:

• widespread damage to surrounding tissues, regardless of the stability of the endoprosthesis components;
• failure of a previous attempt to maintain a stable endoprosthesis;
• stable endoprosthesis in the presence of gram-negative or multi-resistant microbial flora;
• the possibility of suppressive antimicrobial therapy.

Therapeutic tactics during two-stage repeat arthroplasty

Stage I - revision:

thorough surgical treatment of the wound;

removal of all components of the endoprosthesis, cement;

installation of an articulating spacer with

ALBC;

parenteral antibacterial therapy (three-week course).

Interim period: outpatient observation, suppressive oral antibiotic therapy (8-week course).

Stage II - re-endoprosthetics, parenteral antibacterial therapy (two-week course).

Outpatient period: suppressive oral antibiotic therapy (8-week course).

Clinical example of two-stage revision arthroplasty using a combined trochlear-medullary spacer.

Patient T., 59 years old. In 2005, total arthroplasty of the right hip joint was performed for a pseudarthrosis of the right femoral neck. The postoperative period was uneventful. 6 months after surgery, type II paraendoprosthetic infection was diagnosed. In the department of purulent surgery, an operation was performed: removal of the total endoprosthesis, revision, sanitation, drainage of the purulent focus of the right hip joint with the installation of a combined trochlear-medullary spacer. Skeletal traction for 4 weeks. The postoperative period was uneventful. Three months after the revision, re-endoprosthetics of the right hip joint was performed. The postoperative period was uneventful. At long-term follow-up, there are no signs of recurrence of the infectious process.

Clinical example of two-stage revision arthroplasty using an articulated spacer.

Patient T., 56 years old, was operated on in 2004 for right-sided coxarthrosis. Total endoprosthetics of the right hip joint was performed. The postoperative period was uneventful. 9 months after surgery, type II paraendoprosthetic infection was diagnosed. In the department of purulent surgery, an operation was performed: removal of the total endoprosthesis, revision, sanitation, drainage of the purulent focus of the right hip joint with the installation of an articulated (articulating) spacer. The postoperative period is without complications. Three months after the revision, re-endoprosthetics of the right hip joint was performed. The postoperative period was uneventful. During follow-up for 14 months, no signs of recurrence of the infectious process were detected.

Revision with three-stage revision arthroplasty

It is not uncommon for a surgeon to be faced with significant bone loss in either the proximal femur or the acetabulum. Bone grafting, which has been successfully used in aseptic re-replacement of total endoprosthesis, should not be used if there is an infection in the area of ​​the upcoming operation. In rare cases, the patient may undergo an endoprosthesis replacement in three stages. This type of treatment involves removal of the endoprosthetic components and careful debridement of the lesion, followed by the first intermediate stage of treatment using parenteral antimicrobial therapy. In the absence of signs of an infectious process, bone grafting is performed at the second surgical stage. After the second intermediate stage of treatment using parenteral antimicrobial therapy, the third, final stage of surgical treatment is performed - installation of a permanent endoprosthesis. Since this method of treatment is used limitedly, it is this moment There are no exact data on the percentage of favorable outcomes.

In recent years, reports have appeared in foreign scientific literature about successful treatment of this pathology using two-stage repeat arthroplasty. Here is one of our own similar clinical observations.

Clinical example.

Patient K., 45 years old. In 1989, surgery was performed for post-traumatic right-sided coxarthrosis. Subsequently, repeated endoprosthetics were performed due to instability of the components of the total endoprosthesis. Bone deficiency according to the AAOS system: acetabulum - class Ill, femur - class III. In 2004, re-endoprosthetics was performed due to instability of the acetabular component of the endoprosthesis. In the early postoperative period, type I paraendoprosthetic infection was diagnosed. In the department of purulent surgery, an operation was performed: removal of the total endoprosthesis, revision, sanitation, drainage of the purulent focus of the right hip joint with the installation of an articulated (articulating) spacer. The postoperative period is without complications. Three months after the revision, re-endoprosthetics of the right hip joint, bone auto- and alloplasty were performed. The postoperative period was uneventful. During follow-up for 1 year, no signs of recurrence of the infectious process were identified.

Other surgical procedures

Unfortunately, it is not always possible to preserve the endoprosthesis or carry out staged re-endoprosthesis. In this situation, surgeons have to resort to removing the endoprosthesis.

Absolute indications for removal of the endoprosthesis:

• sepsis;
• multiple unsuccessful attempts to preserve the endoprosthesis surgically, including options for one- and two-stage endoprosthesis;
• the impossibility of subsequent re-endoprosthetics surgery in persons with severe concomitant pathology or polyallergy to antimicrobial drugs;
• instability of the endoprosthesis components and the patient’s categorical refusal to undergo re-endoprosthetics.

If there are absolute indications for removal of the endoprosthesis and it is impossible for one reason or another to carry out re-endoprosthesis at the final stage of surgery aimed at sanitizing the infectious focus (the exception is “patients with sepsis”), the method of choice, along with resection arthroplasty, is to perform operations aimed at to preserve the weight-bearing ability of the lower limb. The staff of our institute have proposed and implemented: the formation of a support for the proximal end of the femur on the greater trochanter after its oblique or transverse osteotomy and subsequent medialization; the formation of a support for the proximal end of the femur on a fragment of the iliac wing taken on a feeding muscular pedicle, or onto a demineralized bone graft.

Hip disarticulation may be necessary when there is a chronic, recurrent infection that poses an immediate threat to the patient's life, or when there is severe loss of limb function.

In some cases, with chronic recurrent infection that persists after removal of the total endoprosthesis in patients with significant residual bone-soft tissue cavities, it becomes necessary to resort to plastic surgery with a non-free island muscle flap.

Method of non-free plastic surgery using an island muscle flap from the lateral thigh muscle

Contraindications:

• sepsis;
• acute phase of the infectious process; pathological processes preceding injury and (or) previously performed surgical interventions in the recipient area, making it impossible to isolate the vascular axial bundle and (or) muscle flap;
• decompensation of the function of vital organs and systems due to concomitant pathology.

Operation technique.

Before the start of surgery, a projection of the intermuscular space between the rectus and vastus lateralis muscles is marked on the skin of the thigh. This projection practically coincides with the straight line drawn between the superior anterior iliac spine and the outer edge of the patella. Then the boundaries within which the blood supplying the flap are located are determined and marked on the skin. An incision is made with excision of the old postoperative scar with preliminary staining of the fistula tracts with a solution of brilliant green. By generally accepted methods an inspection and sanitation of the purulent focus is carried out with the obligatory removal of the components of the endoprosthesis, bone cement and all affected tissues. The wound is washed generously with antiseptic solutions. The sizes of the bone and soft tissue cavities formed during the operation are determined, and the optimal sizes of the muscle flap are calculated.

The surgical incision is extended distally. The mobilization of the skin-subcutaneous flap is performed to the intended projection of the intermuscular space. They enter the gap, pushing the muscles apart with hooks. Within the intended area, vessels supplying the vastus lateralis muscle are found. Plate hooks retract the rectus femoris muscle medially. Next, the vascular pedicle of the flap is isolated - the descending branches of the lateral femoral circumflex artery and vein in the proximal direction for 10-15 cm up to the main trunks of the lateral femoral circumflex artery vascular bundle. In this case, all muscle branches extending from the indicated vascular pedicle to the vastus intermedius muscle are ligated and crossed. An island muscle flap is formed with dimensions corresponding to the tasks of reconstruction. Then the selected tissue complex is passed over the proximal femur and placed into the formed cavity in the area of ​​the acetabulum. The muscle flap is sutured to the edges of the defect.

The surgical wound is drained with perforated polyvinyl chloride tubes and sutured in layers.

Clinical example.

Patient Sh., 65 years old. In 2000, total endoprosthetics of the left hip joint was performed for left-sided coxarthrosis. In the postoperative period, a paraendoprosthetic infection of type I was diagnosed, and the infectious focus was revised with preservation of the left hip joint endoprosthesis. 3 months after the revision, a recurrence of infection developed. Subsequent conservative and surgical measures, including removal of the total endoprosthesis of the left hip joint, did not lead to relief of the infection. In 2003, a revision with non-free plastic surgery with an island muscle flap from the lateral thigh muscle was performed. The postoperative period was uneventful. During follow-up for 4 years, no signs of recurrence of the infectious process were detected.

Currently, there is a continuing trend towards both an increase in the number of hip replacement operations and an increase in various types of complications of these operations. As a result, the burden on the healthcare system increases. It is important to find ways to reduce the cost of treating these complications while maintaining and improving the quality of care provided. Data from many studies on the results of treatment of patients with paraendoprosthetic infection are difficult to analyze, since patients were implanted with various types of endoprostheses, both with and without the use of polymethyl methacrylate. There is no reliable statistical data on the number of revision procedures or the number of relapses of the infectious process preceding a two-stage replacement of the endoprosthesis; the nature of the concomitant pathology is not taken into account; various techniques treatment.

However, two-stage reimplantation demonstrates the highest infection clearance rate and is considered the “gold standard” for the treatment of patients with periprosthetic infection. Our experience with the use of articulating spacers has shown the advantages of this method of treatment, since, along with sanitation and the creation of a depot of antibiotics, it ensures the preservation of leg length, movements in the hip joint, and even some support ability of the limb.

Thus, modern development medicine allows not only to preserve implants in conditions of a local infectious process, but, if necessary, to perform staged reconstructive operations in parallel with stopping the infectious process. Due to the high complexity of re-endoprosthetics, this type of operation should be performed only in specialized orthopedic centers with a trained operating team, appropriate equipment and instruments.

R.M. Tikhilov, V.M. Shapovalov
RNIITO im. R.R. Vredena, St. Petersburg

​Modern production methods allow us to produce high-quality endoprostheses long term services. At careful attitude to their health, they will serve the patient for decades.​

​An important point is the patient’s refusal to cooperate with the doctors. In young patients, dislocation of the endoprosthesis occurs no more often than 1.2%, while in older people the percentage is higher - 7.5.​

​Also absolute contraindications include the inability to move independently and polyallergies. Relative contraindications include cancer, liver failure, osteopathy (hormonal), obesity (III degree).​

• ​deforming coxarthrosis degree III;​
• ​An important part of it is the friction unit. It consists of two parts - the liner (articular cavity) and the head of the endoprosthesis on a stem, which is fixed in the femur. The durability of the prosthesis depends on the material from which the friction unit is made.
• ​The hip joints are the largest and most heavily loaded in our body. They experience constant stress and are therefore at risk. A sign of incipient problems is pain in the hip joints. It may occur due to various reasons(dislocation, fall, illness).​
• ​It will be easier for the patient after the operation if he can, while sitting in a chair, put his leg on a small bench;​
• ​It is very important that the patient is of normal weight before surgery. This can significantly ease the postoperative period, reduce the load on the joint, and minimize complications. If physical activity due to pain in the hip joint is impossible, then a diet aimed at reducing weight to normal levels is indicated.​

​Hip replacement, the price of which depends on the material of the prosthesis, is performed under general or spinal anesthesia.​

​Weakening of the joint, which may be accompanied by pain in it. Elimination of this complication is only surgical.

• ​Hip replacement (endoprosthetics) is an operation that results in the complete replacement of diseased cartilage and bones with artificial prostheses consisting of a concave cup and a spherical head. The main goal of this surgical procedure is to reduce pain caused by various diseases joint.​
• ​Patients are not recommended to bend their leg at an angle of more than 90° or turn it inward after installation of the implant. Dislocation of the artificial head of the joint can also occur due to a fall. The symptoms are similar to a dislocated healthy joint. This is a sharp pain, swelling, forced position of the operated leg and its shortening. If the patient does not see a doctor after a dislocation, the temperature may rise due to the onset of inflammation.​
• The patient is hospitalized two days before the scheduled date of the operation. At this time, all necessary procedures are carried out with the patient, and, if necessary, maintenance therapy is prescribed or adjusted. Progress of the operation:​
• ​post-traumatic coxarthrosis (serious damage to the acetabulum);​
• ​Hip replacement is a complex operation (although its duration is short). Therefore, the initial examination, selection of the optimal endoprosthesis and postoperative rehabilitation are very important (the use of NSAIDs is mandatory to prevent severe pain).​
• ​The main reason when joint replacement is indicated is coxarthrosis.​

​you can make for yourself a list of items that should always be within the reach of the patient: mobile phone, glasses, book, telephone directory, necessary medications, water, TV remote control;​

​Some patients feel calmer if they know that the ideal blood for transfusion is available. And sometimes the surgeon may insist on this. To do this, a reserve of your own blood is created in advance. If for some reason this is not possible, then you can find a donor in advance from among your close friends and relatives. The blood is examined for all kinds of infections and then frozen. In this form, blood can be safely stored for about a month.

• ​Complications after endoprosthetics are possible, but they occur much less frequently than after other treatment methods. Wherein physical activity begins to recover the very next day after the operation, and after the end of the rehabilitation period the patient can walk independently, even without the help of crutches.​
• ​But the main danger of this method is the high probability that the bones will not heal.​
• ​Hip replacement can lead to thrombosis. If movement on the operated leg decreases, blood stagnation in the veins may develop. To prevent this, the patient is not allowed to lie down for a long time and is prescribed anticoagulants.​
• ​When is endoprosthetics performed?​
• ​Hip replacement significantly improves the patient's quality of life, but an artificial joint head cannot replace a real one.​

​Preparation for endoprosthetics involves spinal anesthesia, cutting the skin over the operated joint, cutting soft tissues and the joint capsule. After this, the surgeon gains access to the destroyed joint.​

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Femoral neck fracture in the elderly, endoprosthetics at the FCS clinic

​tumor in the area of ​​the femoral neck or its head.​ Surgical treatment ​The decision to undergo surgery is made by the doctor and the patient. It is important to explain to the patient that refusal to undergo surgery will result in disability and, in some cases, complete immobility. The patient should be aware that complications are possible after hip replacement:​ ​Abrasion articular head leads to severe pain that cannot be relieved even with non-steroidal anti-inflammatory drugs.​ ​If energetic and temperamental animals live in the house, then it is better to temporarily remove them from the house to avoid the patient falling.​ You definitely need to get your teeth in order. A tooth affected by caries is a potential source of infection, which can lead to postoperative complications. The doctor prescribes the first simple exercises the next day after endoprosthetics; subsequently, the set of exercises expands and their intensity increases. For 10 days, patients are in the hospital, under constant supervision, after which they can be discharged for further rehabilitation at home.​ Hip replacement Today, surgical treatment is the most rational way to restore the patient’s ability to work. There are two surgical options:​ Ossification is the impregnation of the tissues surrounding the joint with calcium salts. This factor can lead to limited joint mobility.​ ​Hip replacement is performed for the following diseases:​ To avoid dislocation, the patient must be very careful, not make sudden movements, and monitor the appearance of warning symptoms. A systematic visit to the doctor is necessary.​ Next comes the stage of dislocation (twisting) of the femoral head from the acetabulum. A template is installed and the proximal femur is cut. After this, the sawed-off head of the joint is removed, the acetabulum is processed with cutters (prepared for installation of the acetabular component of the endoprosthesis). The acetabular component is fixed either with cement or with screws. Then the liner is installed.​ ​For a fracture of the femoral neck and aseptic necrosis of the head (III–IV degree), surgery is also necessary.​ ​danger of blood clots in damaged vessels;​ Rehabilitation An artificial mechanism that is installed in the human body for one reason or another is called an endoprosthesis. Endoprosthetics is a complex operation to remove part of the destroyed bone and replace it with an implant. The service life of a modern endoprosthesis is long (on average 15–20 years). At the end of this period, the artificial joint is replaced with a new one (re-endoprosthesis surgery is performed).​

​The preparation of the bathroom and toilet for a person after joint replacement surgery deserves special attention. It is imperative to provide the bathroom and toilet with grab bars. It would be a good idea to purchase a chair in advance on which the patient will take a shower. It must be sustainable. In addition, you need to take measures to prevent this chair from slipping. Soap, shampoo and everything else you might need in the bathroom should be within reach while sitting on a chair. The toilet will have to be raised so that the knees of the person sitting are higher than the hip joint.​

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The surgeon must be informed about all medications taken. This also applies to medicinal herbs.​

Indications for hip replacement

​Call us:​

Osteoarthritis of the hip joint

​1. Osteosynthesis, or reposition.​

Femoral neck fracture

​Displacement of the prosthesis. May occur during certain movements. To avoid this complication, patients should not cross their legs or bend their hip joints more than 80 degrees.​

Arthritis

​Arthrosis.​

The dislocation is reduced under anesthesia (intravenous or spinal). After this, the limb is fixed. If the dislocation cannot be corrected, they resort to surgery.​

Preparation for prosthetics

​The hip joint endoprosthesis is installed in the femur. To do this, the bone marrow canal is opened. Next, it is prepared for implantation using osteoprofilers. The femoral part of the endoprosthesis is installed into the prepared hole. The head is installed in the acetabulum.​

After clarifying the medical history and conducting an examination, chronic diseases are identified. Absolute contraindications for endoprosthetics are systemic diseases:​

​large blood loss during and after surgery;​

​When performing hip replacement surgeries, two types of anesthesia are used.​

​Some medications will need to be stopped in advance.​​Some injuries and their consequences, as well as some diseases, lead to the fact that the only chance for a full life is a hip replacement.​

​With this method, femoral bone fragments are compared in such a way as to ensure their maximum contact, and then fixed with metal screws. Such operations can extremely rarely be recommended for older people, primarily due to the low likelihood of bone fusion.​

How to prepare your home for the post-surgery period

​Change in the length of the operated leg. This complication occurs as a result of relaxation of the muscles surrounding the joint. This problem can be solved by performing special physical exercises.​

• ​Femoral neck fracture.​
• ​The service life of modern endoprostheses is more than 20 years. Many patients live up to 30 years after surgery without any problems and do not show any complaints. However, sooner or later re-endoprosthetics will be required - this is the replacement of a worn-out implant with a new one.​
• ​The surgeon checks how the limb will function (moves it in different directions). If everything is fine, they are sutured first. soft fabrics, then sutures are placed on the skin. A drainage tube is installed to drain possible blood. The operation lasts no more than two hours, depending on the degree of destruction of the hip bone.​
• Cardiovascular and bronchopulmonary (in the acute stage);
• ​infection at the site of installation of the prosthesis (the patient has a fever, pain is felt in the area of ​​the operated joint, the skin is hyperemic);​
• ​The endoprosthesis can be made of titanium and steel alloys (stainless), ceramics and high-strength plastics. The peculiarity of these materials is their strength and, at the same time, ease of processing. It is quite difficult to make a high-quality endoprosthesis, so there is control at every stage of production. All products have their own quality certificate. ​
• The medicine in a gaseous state enters the lungs through a special mask. After the patient has fallen asleep, a tube is inserted into his airway to artificial ventilation lungs. Using various sensors, the anesthesiologist monitors the patient’s condition throughout the entire operation.​
• ​As part of the overall health of the body, it is very advisable to stop smoking before hip replacement surgery. This measure will also help prevent complications.​

​Hip replacement is indicated for certain types of injuries and diseases of the bones and joints.​

Anesthesia during surgery

​2. Endoprosthetics.​

General

​Hip replacement surgery​

Regional

​Polyarthritis.​

​The operation is more complex than primary endoprosthetics, since it is necessary to remove the old prosthesis, clean out the acetabulum and the canal in the hip bone.​

The postoperative period is long. The patient can begin to move within the first day. On the second day, light gymnastics in a sitting position is allowed. You can walk with the help of a walker already on the third day. The stitches are removed after about two weeks. All this time, the patient receives full treatment with antibiotics and painkillers. Additionally, symptomatic treatment may be prescribed for mental disorders and problems with the nervous system;

​risk of developing pneumonia;​

​The artificial joint can be fixed with cement based on acrylic resin and an alloy of chromium or cobalt, or installed without it.​

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Hip replacement or endoprosthesis: preparation for surgery

​There are two types of regional anesthesia: spinal, epidural, or a combination of both. During the operation, the patient is asleep, but he wakes up immediately after the operation, without feeling pain.​

​First of all, it is necessary that someone is constantly with the patient after the operation. In addition, you will have to adapt your home in such a way as to make the patient’s life as easy as possible:

​This disease is a consequence of damage to the cartilage tissue of the joint. Most often, cartilage wears out with age, so this condition is common in older people. Less commonly, arthrosis develops as a result of injury.​

What is endoprosthetics

​In this case, damaged bone and joint fragments are replaced with implants, providing full recovery mobility. The method is highly effective and allows you to return to physical activity as quickly as possible.​

Types and materials of endoprostheses

​Basically, endoprosthetics is carried out according to the general scheme:

​Disturbance of the blood supply to the hip joint.​

​The new acetabular liner will be larger, as will the head of the implant. ​

​When lying on the bed, it is important to keep a thick pad between your legs. It helps maintain the correct position of the operated leg. After the sutures are removed, the patient is discharged. For the next 2 months after surgery, it is recommended to limit the weight on your leg. You need to walk, but with the use of crutches or a walker.​

1. ​long-term infection in the area of ​​the damaged joint (3 months or more);​
2. ​dislocation of the endoprosthesis (treatment period increases);​

​Hip replacement is divided into two types:​

The type of anesthesia is discussed with the patient in advance. The anesthesiologist studies the medical history, talks with the patient before the operation, explains to him the principle of action and possible side effects from different types anesthesia, after which, having all the necessary information, the patient decides on the method of pain relief during joint replacement surgery.​

​all items needed in everyday life should be placed at arm's length;​

​In old age, such a fracture may no longer heal. In this case, joint replacement is not only the ability to walk, but also, in principle, to live.​

How is the treatment carried out?

​Surgery to replace damaged areas with endoprostheses is the most reliable method of treating a hip fracture, especially in older people, and in some cases, such as significant displacement of fragments or a complex fracture, it is the only option to restore mobility.​

• ​An incision is made on the lateral or frontal surface of the thigh.​
• ​Necrosis of the femoral head, which may be caused by taking certain medications or performing certain surgical interventions (for example, kidney transplantation).​
• ​Reendoprosthetics may also be required in case of accidental injuries to a previously operated hip. Therefore, it is very important to take care to ensure that the implant lasts as long as possible. Preparation for re-endoprosthetics is no different from primary prosthetics. It is shorter in time, since the attending physician already has a complete medical history.​
• ​Hip replacement can be complicated by dislocation. There are several reasons - the structural features of the artificial articular head, the human factor (the patient himself is to blame), the surgeon’s mistake due to lack of experience (in particular, performing the operation from behind). At risk are:​
• ​acute vascular diseases of the extremities;​
• ​looseness (of the leg or head), resulting in a paraprosthetic fracture.​

​replacement of the articular head;​

Indications

​You can’t eat anything 12 hours before surgery, and you can’t drink anything 7 hours before surgery. You will be able to eat for the first time after the operation in the evening of the same day.​

• ​if the house has more than one floor, then you need to make sure that everything necessary for a person after surgery is located on the ground floor;​
• ​Inflammation in the joint can lead to irreversible consequences. Sometimes complete joint replacement is the only possible way to restore mobility to the patient.​
• ​Endoprosthetics can be:​
• ​Cartilage tissue or affected bone is removed.​

However, hip replacement is not performed immediately after diagnosis. Surgical intervention is carried out only when pain in the joints becomes permanent and contributes to the worsening of the most simple functions(walking, climbing stairs, etc.) and cannot be relieved with the help of strong painkillers.​

Contraindications

​Joint operations help desperate patients experiencing constant severe pain to be able to move independently, even with a crutch or cane.​

• ​patients with hip fracture and dysplasia; ​
• ​a source of infection in the body (including caries, tonsillitis, sinusitis);​
• ​Immediately after surgery, the patient may develop a fever. This is the body's reaction to surgery. Therefore, taking antibiotics for 10 days after surgery is mandatory.​
• ​replacement of cartilage tissue (with undestroyed bone).​
• Sometimes the patient may experience nausea due to anesthesia. There is no need to endure it; it is better to seek help, and the doctor will prescribe a medicine to relieve nausea.​
• ​it is better to free up as much space as possible from unnecessary furniture and other objects in order to ensure that the patient on crutches can move freely around the room and between them;​
• ​Hip replacement in most cases allows the patient to have an absolutely normal, fulfilling life.​

​unipolar, when only the neck and head of the femur are replaced;​

Operation

​Implantation of the cavity coupling is performed.​

1. ​Are there any risks with this operation?​
2. ​The preparation takes a little time. You need to undergo a full examination, based on the results of which the doctor will make a diagnosis and recommend treatment. The conservative method often does not pay off, since a damaged joint cannot be restored with medication or other non-surgical methods, and the pain intensifies over time.​
3. ​have undergone previous surgical interventions;​
4. ​young age (when the skeleton is in the growth stage);​
5. Endoprosthetics have become popular due to frequent injuries to the hip joints. Installation of implants helps patients lead an active lifestyle, take care of themselves, and work. Hip replacement is indicated for the following diseases:​
6. ​The second option is a priority for young active people. It leaves the bone intact, thereby maximizing the preservation of all motor functions of the joint. This operation is much simpler than with the installation of a full-fledged implant; in the postoperative period the patient feels almost no pain. There is also an endoprosthesis with a shortened leg. It allows you to save more of the patient's femur, while holding as firmly as a standard one.​

Symptoms of endoprosthesis dislocation

​It is very important to trust the surgeon and anesthesiologist. At proper preparation and rehabilitation after surgery, the patient does not face complications. A positive attitude and support from loved ones before surgery and in the postoperative period can work wonders.​

• ​you need to purchase in advance a good, durable chair in which the patient sits so that the knees are below the hip joint, which will allow him to stand up easily;​
• In order to avoid complications, you need to carefully prepare for joint replacement surgery. Before the operation, it is necessary to undergo a complete examination of the body. All chronic diseases are taken into account. A course of treatment is prescribed so that the patient is as healthy as possible by the time of surgery. The condition must be corrected in the case of arterial hypertension, diabetes mellitus, and blood clotting disorders. A suitable anesthesia is selected.​
• ​Bipolar or total, if the acetabulum of the pelvic bone is also replaced.​

​The hip hinge is replaced with an artificial prosthesis that is attached to the hip bone.​

​Like any other surgical intervention, endoprosthetics may have complications:​

​The doctor must explain to the patient that joint replacement will help get rid of pain and give the opportunity to live a full life.​

​Patients with joint hypermobility.​

​absence of the medullary canal of the hip bone (if hip replacement surgery is performed).​

Reendoprosthetics

​one- and two-sided deforming arthrosis (II–III degree);​

​For each patient, the endoprosthesis is selected individually.​

​the house needs to be inspected as if you lived there Small child, and remove wires, sharp corners, slippery surfaces, thresholds in doorways, and you also need to make good lighting throughout the house, including corridors;​

Advantages of endoprosthetics

To facilitate the postoperative period, the patient is prescribed special exercises. It's important to have Strong arms and developed torso muscles. It will be difficult to learn to walk with crutches after surgery. It is better to master this skill in advance.​

Implants are attached using a cementless or cement method. The first method is more suitable for young patients, since in this case prostheses with a porous structure are used, which are connected to the bones without additional fixators.​

​A suture is placed at the incision site.​

​Penetration of infection into surgical wound or at the site of installation of an artificial prosthesis. This may manifest as redness, swelling and pain at the surgical site. To prevent such complications, antibiotics are prescribed.