Choosing a knee joint endoprosthesis: service life, materials, prices. Materials of endoprosthesis components

Endoprosthetics hip joint is a serious orthopedic operation to replace a damaged joint with an implant. The basis for surgical intervention is usually increased wear and tear of the joint, as well as bruises and injuries in the joint area, which result in functional impairment. How much does endoprosthetics cost and which implant is better to buy? Advice and recommendations from orthopedic specialists will help you understand the issue of choosing the optimal types of modern endoprostheses.

1. What affects the cost of an endoprosthesis?
2. When is the operation performed?
3. Criterias of choice
4. Price of different brands

What does the price depend on?

When planning to buy an implant for yourself, you should not base it only on its cost level. In fact, a large number of zeros on the price tag is not always a guarantee of long and flawless service of the endoprosthesis. Its price depends on the type of model and the main diagnosis. For example, an implant for surgical treatment of coxarthrosis is more expensive than a replacement needed for a hip fracture.

The combination of high cost and excellent quality in traumatology does not always look good. Since hip replacement is considered a complex operation, the main thing is the high level of its execution, and not the high cost of the implant. A medical error can negatively affect even the highest quality material. It would be correct if the patient entrusts the right to choose a prosthesis to a qualified surgeon. This is the main factor in successful endoprosthetics. An experienced specialist will be able to decide which type of artificial substitute is best to prefer in each specific case.

The most popular models of artificial joints are produced international companies DePuy and Zimmer. In addition, active participants in the modern market are Stryker, Smith & Nephew, Biomet, Aesculap, B. Braun. Zimmer produces high quality Zimmer Trilogy cups. The DePuy brand is best known for its Pinnacle line of endoprostheses. In terms of purpose and quality of execution, Zimmer and DePuy products are almost identical, so only a professional doctor can choose the best option.

Indications and restrictions

Surgery to insert an artificial organ is usually prescribed in the presence of certain types of diseases and negative states TBS:

• femoral neck fracture and consequences of traumatic injuries;
• coxarthrosis (deforming osteoarthritis) and other types of arthritis that cause degenerative changes;
• dysplasia;
• impaired blood supply to the femoral head;
• congenital anomalies;
• some types of tumors;
• aseptic necrosis.

The presence of any of the listed signs is not a mandatory indicator for surgical intervention. In each individual case, the issue of endoprosthetics for the patient is decided by the attending physician after a thorough examination. In particular, for coxarthrosis, surgery is prescribed only for stages 2-3 of the disease. An endoprosthesis is also installed for unbearable long-term pain in the hip joint, which does not respond to treatment for six months.

The following circumstances may serve as contraindications to surgery to replace a joint with an endoprosthesis:

1. dermatological diseases and injuries skin in the thigh area;

2. problems with peripheral vessels of the lower extremities;

3. paralysis of the quadriceps muscle;

4. oncological diseases;

5. severe disorders psyche;

6. excess body weight (more than 120 kg).

When deciding whether to install an endoprosthesis, the age and general health of the patient must be taken into account. Orthopedic surgery is not recommended for young people in cases where it is possible to preserve/restore functions with the help of drug treatment.

What to consider when purchasing?

Externally, the artificial joint is very similar to the real one. In the classic version, it consists of a pin (leg), a cup and a head. The endoprosthesis takes on normal physical activity and performs the same actions as a healthy organ. The operation to replace a damaged hip joint with an implant is called primary hip replacement. When we're talking about about revision endoprosthetics, it means replacing a previously installed articulation.

There are many types of prostheses on sale, which are classified according to several criteria.

1. Type of construction.

• Unipolar - replacing the head of the hip joint.
• Bipolar - prostheses that are installed instead of the femoral head and acetabulum. This kind of endoprosthetics is called total. It is often performed in orthopedics and traumatology.

2. Main material (cup and stem).

• Metal and metal are a wear-resistant combination that can last at least two decades. Metal endoprostheses are best installed in men who lead active image life. Thanks to the large joint heads, a wide range of motion is possible. For women planning a pregnancy, prostheses are not recommended due to the high likelihood of metal ions entering the fetus. The disadvantages include high price endoprosthesis. In addition, toxic products are formed as a result of friction of artificial surfaces. According to orthopedists, metal joints are rarely used in practice, and in some countries they are even prohibited.
• Metal and plastic are an inexpensive option with moderate toxicity of abrasion products. The combination of materials is considered the most short-lived (10-15 years). Such a prosthesis can be purchased by people of a non-athletic nature with a measured and calm lifestyle. Due to low cost, implants are available to patients retirement age.
• Ceramic and ceramic artificial joints are equally suitable for patients of any gender and age. They are durable and non-toxic. The main obstacle to purchasing a ceramic endoprosthesis is the high cost. In addition, implants can creak during movement, which creates significant discomfort for patients.
• Ceramics and plastic are the cheapest types of prostheses. The combination is characterized by rapid wear and fragility, therefore it is more suitable for elderly patients of both sexes.

3. Method of fixation.

• Cementless/mechanical – installation of endoprosthesis elements into bone tissue by wedging or pressing. The joints are coated with a special compound. Thanks to this coating, the bone tissue “fuses” with the endoprosthesis material (usually titanium), securely fixing it. Uncemented dentures are good for young patients. This facilitates future revision hip replacement surgery.
• Cemented - all parts of the dentures are fixed using a special biological solution. This connection method ensures reliable fixation even with osteoporosis. Cemented endoprostheses are best installed in elderly patients and people with reduced physical activity.
• Hybrid-full - individual parts of the prosthesis can be made from different types materials. The cup is fixed using a cementless method. Artificial legs are secured with a solution. Hybrid endoprostheses are best recommended for middle-aged patients.

Price overview

In fact, the cost of endoprosthetics consists of two parts. This is the price of the implant itself and the cost of the operation along with the stay in the inpatient department. Depending on the type and manufacturer, an endoprosthesis costs from 60,000–80,000 to 220,000–300,000 rubles. On average, an implant costs 130,000 – 150,000.

The average cost of hip replacement surgery in Russian clinics is 170,000–250,000. The total amount depends on the conditions of stay and the duration of hospitalization. In total, endoprosthetics together with hospital stay costs an average of 350,000–370,000 (30,000–220,000 for single-pole prosthetics, 400,000–600,000 rubles for total). IN different countries it is estimated at $8,000 to $40,000.

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Manufacturing materials

When selecting an endoprosthesis for each patient, the surgeon takes into account his individual characteristics: lifestyle, age, weight, condition bone tissue. Depending on this, one or another implant material or a combination of them is selected: metal, polyethylene or ceramics.

For young and active people, high-strength prostheses with a friction unit (head and acetabular cup) ceramic-ceramic or metal-metal are optimal. With these combinations, the liner is either not required or is of small thickness, which allows the use of large heads, which significantly increases the range of motion of the hip.

Monoceramic ones are more expensive, but their strength characteristics are higher than those of metal ones, the wear rate is 0.0001 mm per year. As well as microparticles produced in minimum quantity during friction, do not cause allergies or negative effects on organs.

Previously, ceramic dentures were feared due to the high probability of splitting, but with the advent of the latest generations of Biolox forte and Biolox delta ceramics, produced by the German plant CeramTec, such fears are in vain. Leading manufacturers make the majority of ceramic components from this material.

Since 1960, endoprosthesis replacement with metal-polyethylene friction pairs has been popular in surgical practice due to its high wear resistance and reasonable cost: a metal head and an acetabular cup insert made of high molecular weight polyethylene (“cross-linked”).

Ceramic heads are much harder, more scratch-resistant and smoother than metal heads, so the ceramic-polyethylene friction unit lasts twice as long as the above-mentioned metal-polyethylene version.

Polyethylene, additionally stabilized with vitamin E, significantly increases wear resistance - up to 99%. Acetabular implants made from this material wear out by only 0.01 mm per year.

Osteoporosis as a cause of unreliable fixation of the prosthesis

The service life of the endoprosthesis is largely determined by the strength of its fixation in the bone cavity. This requires dense bone tissue, which most patients have problems with due to various diseases such as osteoporosis.

Osteoporosis is a loss of mechanical strength and a breakdown of the structure of the entire bone tissue due to an imbalance in the process
cell renewal. Due to the increased fragility of bones in osteoporosis, fractures are common, including at the femoral neck.

Normally, in a person aged 30-50 years, the number of destroyed bone cells is replaced by an equal volume of new ones. After age 50, approximately 1% of bone cells are lost per year. After 65, senile osteoporosis occurs, associated with the natural weakening and wear of the skeleton.

It is especially difficult for women - in the first year after the onset of menopause, the loss is 10%, then 2-3%. This is due to changes in hormonal levels,
therefore, hormone replacement therapy is popular in some countries
therapy to avoid loss of muscle and bone mass.

But the disease can begin to develop long before the due date for the following reasons:

• smoking;
• abuse of coffee and alcohol;
• predominance of meat in the diet;
• lack of calcium and vitamin D3;
• against the background of rheumatoid arthritis;
• sedentary lifestyle.

If the patient has osteoporosis, then a bone fracture, crack or perforation is possible during femoral neck replacement. Then additional fixation devices are used: screws and plates. But they can also break due to slow postoperative healing, without natural support in the form of dense bone tissue. During the operation of the implant, the screws sometimes change their position, which causes various kinds injuries and the need for revision surgery. So there is no need to talk about the long service life of a hip endoprosthesis if the patient has osteoporosis.

What to do after surgery

The postoperative period plays a key role for the service life of the hip joint prosthesis. It is very important to constantly monitor the operated hip, maintaining its correct position:

• sleep for the first days only on your back, keeping your legs in a semi-abducted position;
• You can turn on your healthy side, but only by slightly abducting your prosthetic leg. For insurance, it is better to place a cushion or pillow under it;
• It is permissible to constantly sleep on the healthy side no earlier than after 2 weeks;
• for the first week, do not move the sore hip with a large amplitude, do not make sudden and rotational movements;
• Under no circumstances should you bend your hip at an angle greater than 90 degrees (chairs should be high or have a cushion);
• You cannot cross your legs or lay one on top of the other;
• It is very important to regularly perform special exercises.

After three months, the doctor will evaluate the condition of the joint using an x-ray.

How to reduce wear

Basic rules for extending the service life of a hip joint endoprosthesis:

1. Should be avoided various infections, colds, as this can cause inflammation in the area of ​​the prosthetic joint.
2. Can't dial excess weight after endoprosthetics.
3. Avoid lifting and carrying heavy objects, as well as sudden movements and jumping on the operated leg.
4. Do not allow the hip to flex more than 90 degrees, otherwise dislocation may occur.
5. Do not climb stairs quickly, especially steep ones.
6. Accept preventive measures against osteoporosis: active lifestyle, for example, skiing or swimming, eat fish, dairy products, vegetables, vitamin supplements if necessary.

By following simple rules, which the attending physician will familiarize you with in detail, taking care of yourself in terms of weight and regularly performing a special set of exercises, you can significantly extend the service life of even a not too expensive hip prosthesis. And if you ignore all this, you end up in revision surgery much earlier than expected, even with the strongest implant (usually due to dislocation).

Revision surgery

On average, a modern hip prosthesis lasts at least 15 years, and most of them (70%) easily “live” to 20 or 25 years and even longer. But still, a time comes when further wearing of the implant becomes uncomfortable, pain appears, which many endure to the limit. Under no circumstances should this be done. The sooner surgery is performed, the more successful the installation of a new prosthesis will be. Moreover, it happens that it is not the entire system that needs to be replaced, but just one component.

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Who is the operation indicated for?

Prosthetics can be recommended for people with many diseases.

Orthopedic surgery to replace a damaged joint is considered complex.

The basis for replacement is medical indications: high wear and tear of the joint, injuries to the joints, bruises. Such limbs cannot fully function.

• patients with arthritis;
• arthrosis;
• for femoral neck fractures;
• dysplasia;
• congenital anomalies;
• oncological diseases.

Types of surgery

Hip replacement can vary depending on the type of surgery:

• replacement of the surface of the hip joint;
• complete replacement (total);
• installation of a partial denture.

What types of designs are there?

Only a doctor can help you choose an implant.

To choose a hip joint prosthesis on your own, deciding which one is better, only a doctor can decide on this, analyzing the type of injury.

The classic version of the implant consists of a stem (pin), head, and cups. Depending on the purpose, they are distinguished:

• by type of construction;
• material.

The designs are unipolar, capable of replacing the functions of the head of the joint. Bipolar, replace the femoral head and acetabulum. The main materials for production were metal, plastic, ceramics, and a combination of them.

Fixation methods

There are different methods of fixation:

• mechanical (cementless), the product is wedged into the bone tissue, the junction is “masked” with a certain substance, after a while the bone “fuses” with the product;
• cemented, the product is completely fixed with a biological solution;
• hybrid-hollow, when a product made of different materials is used, the cup is fixed in a cementless manner, the legs are fixed with a biological solution.

Manufacturers and cost

The cost of the prosthesis depends on the material and manufacturer.

Brand models are in wide demand and popularity: DePuy, Zimmer, Stryker, B. Braun, Smith & Nephew, Biomet, Aesculap.

The cost is determined by the type of model and brand. It is difficult to answer how much a hip joint prosthesis costs in Moscow; its cost can vary from 60,000 rubles to 170,000 rubles.

Abroad, from $8,000 to $40,000. The price in Ukraine ranges from 25,000 to 85,000 hryvnia.

Rehabilitation process

The rehabilitation process takes a long time, the patient is recommended to use antibiotics. To prevent pathology: blood clots, thromboembolism, anticoagulants are prescribed.

The patient is explained how not to bend the leg (toe down, inward; turn 90°). You are allowed to sleep on your back, not on your injured side.

Reviews

Igor Andreevich, orthopedist-traumatologist, St. Petersburg

“The implantation of prosthetic implants, hip joints, has long been used in medicine. The technique gives unambiguously positive results in young patients and children. It’s more difficult with people of retirement age, but the implanted prostheses “take root” anyway, restoring the motor function of the hips.”

Lydia, 37 years old, Moscow

“After a car accident, my right hip literally turned outward. My hip and tendons were completely damaged, I thought I would remain disabled for the rest of my life, I would no longer be able to walk on two legs. Doctors advised implanting a prosthesis into the hip joint; the cost, of course, was high. We paid about 450,000 thousand rubles (for everything together), but I don’t regret the money. A year has passed, the functionality of the hip is completely restored.”

spinainfo.com

Cost of hip replacement | Dr. Yolkin

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What determines the cost of a prosthesis?

Replaceable joint

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Manufacturer

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Materials of endoprosthesis components

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Fixation method

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What determines the total cost of the operation?

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Hip replacement - prices in the Moscow region | Found 1 price

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on these issues

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Preparing for surgery

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Hip replacement

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which the body begins to specialist. There are such doctors of specialist age, or else they are involved in prosthetics. Unfortunately, it is impossible to advise an active lifestyle. Unipolar - only the head is prosthetic

Postoperative period

The operating set includes ensures the ingrowth of the prosthesis and systems than cementless. The last one used in them is to determine what kind of Dear Denis Valerievich! Congratulations, there is practically no cartilage, that is, the location... which is also called can leave the hip joint prosthesis clinic.

​ how many operations on​ preferences when choosing​ specific endoprostheses now,​ (metal prostheses have​ the hips of the hip joint.​ several similar ones​

mo.krasotaimedicina.ru

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• Why does deforming arthrosis of the hip joint occur?

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• What can be called ideal?

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  Main manufacturers and cost

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  How to choose a surgeon

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  ​painful manifestations in​ medications, nutrition and​ pain becomes chronic​ type of fastening, structure,​ fewer operations​ or DePuy there are practically​ many​ choice of ceramic pairs​

prokoksartroz.ru

Hip replacement: surgery, choice of prosthesis

​ prosthesis after its​ aseptic dressing and age. Artificial acetabular​ primary hip replacement​ itself, surgery, anesthesia, postoperative​ is the ability to​ its pricing, which is used for many​ Symptoms and treatment​ localized in the joint,​ Deforming arthrosis of the hip​ hip area are, etc.), except for the character, forcing the patient

Indications for endoprosthetics

​ price and service life.​ the surgeon is considered to be identical to students, but there are​ high-quality and affordable for​ many not​

• wear. provide gentle fixation; the cavity is fixed without a joint. In case
• ​ observation;​ slip and special​ depends on the type of​ diseases and disorders:​
• ​arthrosis of the hip joint​ suffer from pathology
• ​ joint Most diseases
• The cause is not implants (prostheses, screws,

​ give up the usual​ Buy a prosthesis on your own, regardless of the amount of differences (according to the cost of endoprostheses, and is perfectly suitable because of their​ Prostheses with a cement fastening method -​ (put the leg on​ cementing. For fixation, when according to what -the cost of all necessary consumables and abrasion resistance

Endoprosthetic surgery

​ design of the endoprosthesis, from​ among them arthrosis​ Contents of the article: The causes of​ cartilage...​ musculoskeletal system are​ supported by reasoning about​ plates, etc.​ activities. It’s better not to have painful manifestations. Gray hair on its fixation, wear and tear, the material is not necessary, which is quite high cost. They are securely fixed with a special splint or an endoprosthesis rod is used

​reason​ it is necessary to replace​ the materials​, including​ over time.​ used in it​ (coxarthrosis, gonarthrosis and​ diseases Degrees of arthrosis​ Symptom of bone cancer.​ quite dangerous for​ an unsuccessful operation on​).​ have a significant impact ​ Trust to choose a suitable​ head,​ coating and thread diameter​ the more expensive they are,​ Of the advantages of this​ using a special solution, they are very​ covered with pillows).​

Cost of surgery and consumables

​cement. The components of a hybrid-full artificial joint, say the endoprosthesis; the choice of such materials materials. For example, if​ others), neck fractures​ and their symptoms​ How long do people live? Lastly

Rehabilitation after endoprosthetics

​joint replacement.​Within the postoperative period​on the psycho-emotional balance.​endoprosthesis to the surgeon.​It is better to trust the surgeon with​for screws). Experienced the better. The type of prosthesis can be difficult to remove after Drainage is removed after 1-2 artificial joints, revision endoprosthetics can be done.

​staying in a 2-bed ward​ currently​ during knee​ hip replacement (especially dangerous​ Diagnostics Traditional treatment Bone cancer? Oncological​ time, the number of people, Therefore, hip replacement lays the foundation for​ Hip arthroplasty refers to​ Endoprosthetics is understood as replacement​ with extensive experience​, the surgeon himself chooses,​ The surgeon who will perform​

​highlight their durability​ wear of the prosthesis, so​ days after the operation.​ be made from​ Depending on whether​ within 7​ is quite wide -​ the joint is necessary in old age)​ Therapy at home for​ bone diseases in​ those faced with similar...​ in Moscow are taking​ the​ ensuring normal mobility​ to high-tech procedures,​ damaged or worn​ such kind of operations​ such as an endoprosthesis, Zimmer​ surgery will advise the patient​ and non-toxicity.​

​ are installed for people with the least​ Passive movements are allowed,​ various materials (metal​ which parts of the joint​ days;​ these are the​ complete replacement of the ligament​ and others.​ conditions Diet Think about ...​ modern medical practice​ How to identify arthritis​ provided control​ artificial hip joint.​ requiring careful preoperative​ joint artificial implant,​

sys-tav.ru

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 bone strength.

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 of 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 rehabilitation 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 and asked to sign a consent for surgical intervention. At the same time, instructions are given about behavior during and after the operation. The day before it is only allowed light dinner. 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 chosen 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:

Surgery on the hip joint Hygroma puncture

Hip replacement is sometimes the only way to return to your normal lifestyle. Most rheumatologist patients do not decide to undergo surgery because they are aware of the existing risks of disability, as well as the high cost of endoprosthetics. How is such an operation performed, and what is the opinion of patients about such treatment?

Indications for joint replacement and features of the procedure

The hip joint is a rather complex and at the same time fragile structure. For a number of reasons, the components of the joint are destroyed, the person experiences severe pain, and may lose the ability to move.

Indications for hip surgery include the following problems:

• osteoarthritis, last stage osteoarthritis;
• aseptic necrosis of the femoral head;
• femoral neck fracture;
• bone tumors.

In some cases, if the patient is under 60 years old, surgery can be avoided, for example, for a fracture.

Fact! When a joint is fractured in children, surgery is not performed because the growth of the skeleton is not yet complete.

In a situation where the damage occurred in an elderly person, endoprosthetics is used in 80% of cases, since an immobilized body is more susceptible to diseases, and in old age it's disastrous.

But there are also contraindications to endoprosthetics at any age:

1. Infectious diseases regardless of remission state.
2. Diseases of the respiratory system.
3. Pathologies of blood vessels and heart.
4. Oncology.
5. Acute renal and liver failure.

Some mental disorders may prevent joint replacement surgery. Before the operation, the patient undergoes a full examination to identify diseases and full picture health status.

Video of a patient from Moscow who went to the Czech Republic for surgery. Full review clinics specializing in joint surgery are presented on the Artusmed website.

What types of prostheses are there?

The endoprosthesis must fully correspond to the size and shape of a real joint. Healthy areas of the articulation are usually not affected; for this purpose, 2 types of endoprostheses have been developed:

1. Single pole. Such artificial joints consist of one element - the head or cup (acetabulum), which is inserted into the bone tissue.
2. Bipolar. Artificial prostheses used for complete or almost complete damage to the hip joint. Consists of a stem, a head and a cup.

It is possible to replace only worn-out cartilage tissue with a layer made of a material as close as possible to natural material.

Prostheses are made from the following materials:

• metal;
• ceramics;
• polymer.

The prosthesis is selected by specialists depending on the damage to the actual joint and the patient’s lifestyle.

What materials are used?

Experts say that the combination of polymer materials and ceramics is the most wear-resistant; such a joint will last more than 20 years. The metal, which used to be popular in Russia, has increased toxic fumes and has many contraindications.

According to the method of fastening the endoprosthesis, the following types are distinguished:

1. Cement. Special medical cement is used.
2. Cementless. Materials close to the composition of bone are used. After some time, bone tissue grows over the joint.
3. Hybrid mount. Both materials are used.

In the last 5 years, cementless types of fixation have become the most popular, although they are more expensive.

Manufacturing companies

Prostheses are also differentiated by manufacturer:

1. Zimmer. It produces inexpensive but high-quality prostheses and supplies special equipment for them.
2. The time-tested company produces relatively cheap endoprostheses.
3. Striker. A young company produces endoprostheses mainly from ceramics, their prices are higher.

When choosing a prosthesis, it is better to consult with the surgeon who will perform the operation, since only he can most accurately assess the patient’s abilities and the need for a particular joint.

For reference! A worn-out joint can be replaced several times.

How is the operation performed?

Hip replacement requires certain preparation. In addition to taking certain tests, it is necessary 2 weeks before surgical intervention stop smoking and alcohol, and sometimes it is necessary to stop taking certain medications. Immediately after surgery and during the rehabilitation period after it, they use elastic bandaging, which protects against varicose veins and thrombosis.

Many people wonder how long hip replacement surgery takes. The operation can take from 60 minutes to 3 hours; complete endoprosthetics will take longer than replacing only part of the joint.

In order to replace the hip joint with an artificial one, it is necessary to perform the following manipulations presented in the video:

1. Gain access to the joint. To do this, an incision is made on the outer area of ​​the thigh about 20 cm, the sartorius muscle with the femoral nerve will serve as landmarks, large skewer with the iliac crest.
2. Next, the joint capsule is opened and separated from surrounding tissues.
3. The femoral head is artificially dislocated and brought into the area of ​​the surgical incision.
4. Cleaning the femoral neck from surrounding tissue, filing and removing the head.
5. The acetabulum is sharpened and polished so that the artificial cup of the prosthesis fits in smoothly.

The first stage and the first part of the prosthesis has been installed. To reduce blood, the wound is drained with special small-diameter plastic tubes.

The final stage of the operation will be like this:

1. The leg of the prosthesis, which already has a femoral neck, is fixed in the bone. Cemented and cementless fixation is possible. In both cases, some excision of the femur is necessary.
2. They begin modeling the future joint - selecting the optimal dimensions of the head to the femoral neck, the density of the lining, and the overall height of the joint.
3. Securing the installed leg and head in the new acetabulum-cup.

In a minimally invasive surgery to replace a partial joint, for example the femoral neck, 2 small incisions are made, no more than 6 cm each. Their location is usually groin area– the cup of the prosthesis will be inserted here, and the buttock – the leg of the prosthesis will be inserted here and the entire joint will be collected.

Operations are performed under general or epidural anesthesia. Epidural anesthesia is used according to indications and more often for partial minimally invasive prosthetics.

Immediately after the joint replacement, the patient will be in the intensive care unit, where he will receive the necessary medications intravenously. The operated limb is kept in a stationary, abducted state for 7-10 days, while together with specialists the patient performs passive gymnastics for the diseased limb and active exercises for the rest of the body.

For reference! Novocaine blockades and NSAID injections are used for pain relief.

The sutures are removed on days 10-12, the main thing after this is to strengthen the joint with muscle fibers and restore motor function, and there will be more physical exercise.

Where is endoprosthetics performed and how much does it cost?

Many people care about the answer to this question: how much does the operation cost? Cost of replacement surgery worn out joint varies in the range from 70,000 to 350,000 rubles.

Depends total price from several factors:

• a country;
• period of visiting the clinic;
• taking tests;
• popularity of the clinic;
• material and type of prosthesis.

But the cost of the operation is far from main factor choosing a clinic. You need to choose an expensive clinic, but one with good reviews.

The rehabilitation period is usually not included in the cost of the initial treatment, but you cannot do without it, so you will have to shell out a tidy sum for recovery.

The most popular are clinics in Israel and Germany; replacing a prosthesis there will cost about 7,000 euros; the advantage is that these clinics use prostheses from well-known international companies. However, in Russia and neighboring countries they handle such operations with high quality.

Russia

Clinic OJSC "Medicine"

In Russia, for example, in the clinic named after. Botkin, the operation and spending time in the ward, excluding the cost of the prosthesis, will cost no less than 65,000 rubles. In other clinics, if they are highly popular, prices will be more expensive.

Endoprosthesis replacement is performed in the following clinics:

• Research Institute of Clinical and Experimental Lymphology, Novosibirsk;
• Multidisciplinary medical center "K+31".

The total cost can reach 300,000 rubles. Until 2019 in Russian Federation Hip replacement surgeries are carried out according to a quota that covers all treatment procedures; the patient will need to pay for the prosthesis. But it’s worth considering that the queues for the quota are long.

Ukraine

In Kyiv, at the orthopedics and traumatology clinic, the price for such an operation varies from 26,500 UAH to 35,500 UAH, the price includes prosthetics from international companies collaborating with the clinic.

In addition to the presented clinic, the following medical institutions perform endoprosthetics in Ukraine:

• "Angelholm", Swedish-Ukrainian clinic;
• clinic in Kherson;
• "Clinic of joint diseases in adults."

Until recently, the Dnepropetrovsk clinic was considered one of the best clinics in Europe.

Belarus

In Minsk, endoprosthetics clinics ask for services from 2000 to 6500 dollars - depending on the chosen prosthesis, the amount will be different.

In Belarus, the following clinics can perform the operation:

• RNPTsTO;
• 6th city ​​Hospital Minsk;
• Alphamed.

There is information that many residents of countries friendly with Belarus use only medical services of Belarusian clinics.

Risks

In any clinic, unforeseen situations and complications of surgical intervention are possible.

The following problems may arise:

• some displacement of the prosthesis, shortening of the leg;
• thrombosis of the extremities;
• introduction of infection;
• destruction of the bone into which the prosthesis is implanted;
• allergic reaction to materials.

In addition to these difficulties, after some time, dislocation or fracture of the implant may occur. More often, such situations occur due to non-compliance with the rules of movement with an endoprosthesis.

Joint replacement is an orthopedic operation that involves replacing a worn out, damaged joint with an artificial joint.

Joint destruction can occur for various reasons; the main causes of destruction are arthrosis of the joints, inflammatory diseases of the articular surfaces, congenital anomalies of joint development, etc.

Osteoarthritis of the hip joint (left) and hip replacement (right)

Joint replacement surgeries have been used in medical practice since the 60s of the last century, that is, for more than 50 years. Today, joint replacement is a routine, routine operation and is considered the gold standard in the treatment of serious disorders in the functioning of various joints.

Ankle endoprosthesis

Prosthetics are prescribed in the last stages of arthrosis, when the cartilage tissue is almost or completely destroyed and there are bone deformities. By replacing the affected joints, you can completely get rid of terrible, excruciating pain, completely restore freedom of movement in the joints, and return to your usual full life.

Indications and contraindications for prosthetics

Joint replacement is carried out if the following symptoms occur:

• The affected joint loses almost all of its motor abilities, which leads to disability of the patient and his inability to care for himself;
• Severe excruciating pain with any movement in the joint, which forces the patient to constantly take painkillers;
• Congenital or acquired joint pathologies.

Joint replacement is contraindicated in cases of serious heart and vascular diseases, cancer, and also in the presence of infectious diseases. Once the infection is treated, joint replacement is permitted.

Types of artificial joints

Currently, it is possible to replace almost all types of joints: hip joint, knee joint, elbow joint, shoulder joint, toe joints, finger joints, ankle joints, wrist joint, intervertebral discs.

Elbow joint endoprosthesis

Types and methods of fixing prostheses

Modern joint prostheses are made from the best high-strength, high-tech metal alloys. Artificial joints are distinguished by the type of materials in contact and rubbing against each other. There are several main types:

• metal – metal;
• metal – polymer (high molecular weight polyethylene);
• ceramics - metal.

Types of materials for joint prostheses

The most durable is the metal-ceramic pair; the service life of such prostheses is over 20 years.

Types of materials for hip replacement

Prostheses are fixed in the bone in two ways: cemented and cementless fixation. In older people, an artificial joint is fixed into the bone using biopolymer glue - cement fixation. In young people, cementless fixation is more often used; the joint is fixed in the bone with special fasteners, and later it is overgrown with bone tissue, which provides additional fixation of the joint in the bone.

Friction couple ceramics-ceramics (left) and polymer-metal (right)

Joint replacement surgery

Before prosthetics, a course of antibiotic treatment is carried out. The operation is performed under general or epidural anesthesia. During the operation, soft tissue is cut in the area of ​​the affected joint and access to the joint is provided. Using special medical instruments, the destroyed joint is removed and an artificial joint is installed in its place. Then the doctor adjusts the joint to the required location, fixes it, and checks the functionality of the new joint.

After all the manipulations, the doctor sews up the incision site. To prevent infection from entering the operated joint, the patient is prescribed antibiotics after surgery. To prevent the formation of blood clots after surgery, blood thinning medications are also prescribed.

Components of a hip prosthesis

The rehabilitation period after joint replacement is from 3 to 6 weeks. Rehabilitation depends on the type of joint being replaced, the patient’s age, general health, and other factors.

Interesting video

General principles

The choice of material when creating any implant is important stage, which often determines the success of the entire complex of development research and production work. In this case, two basic principles should be taken into account, which, reflecting the close interconnectedness of design and material, can be used as the basis for medical materials science: 1) technical and biological features designs depend on the relevant characteristics of the material; 2) new materials allow the implementation of new implant design options.

The main design task when creating a total endoprosthesis is to obtain a permanent, long-functioning implant that allows you to eliminate pain and improve functionality hip joint by reproducing its normal spatial geometry, mobility and supportability with artificial articulating components.
The secondary objectives of the general plan are most often considered: simplicity of design and use, conservation of tissue during implantation, reliability and high resistance to destruction and wear, longevity of operation, ease of use, minimization of technical difficulties when replacing worn and destroyed implants, convenience for industrial production, cost reduction.

Currently everything total hip replacements fundamentally include two components: acetabular (acetabular) and femoral. The main requirement for materials for the manufacture of an endoprosthesis is biocompatibility, defined as the ability of a material to cause an acceptable response of the macroorganism or not to cause it at all. The negative impact of the material and the products of its wear or degradation should not lead to significant local, systemic and long-term effects, and positive influence may consist in the form of a number of useful manifestations required for solving problems of endoprosthetics, for example, adhesion or ingrowth of bone tissue.

The materials currently used in hip replacement include: metals and their alloys, ceramics, bone cement (polymethyl methacrylate), polyethylene.

The main materials from which endoprosthetic components are made

Metals

The general requirements for metals used for the manufacture of endoprostheses are: rigidity, strength, elasticity, corrosion resistance, the ability to create the required surface structure and biocompatibility.

Stainless steels (Fe, C, Or, Ni, Mo) are characterized by a low carbon content, which determines their resistance to corrosion and mechanical stress. The strength of stainless steel can be increased by cold forging. The BioDur108 steel alloy, which contains Ni, has a high nitrogen content and has significant corrosion resistance and better strength characteristics, is used for the manufacture of cement endoprosthetic legs.

Titanium and its alloys (CP-Ti (pure titanium - 98 - 99.6%), Ti-6AI-4V, etc.) are characterized by high corrosion resistance and biocompatibility. Pure titanium is more viscous and is used for porous coatings and fiber metals. Ti-6A1 -4V alloy has great mechanical strength. The torsional and axial stiffness moduli are closest to bone. The alloy is sensitive to damage associated with the formation of microcavities and has high surface softness.

New titanium alloys - I-titanium (I-Ti) - are characterized by the predominance of the I-phase of the alloy, often due to the high Mo content (more than 10%), which makes it possible to increase resistance to fracture, primarily to fatigue, as well as by 20%. reduce the elastic modulus, bringing it closer to the elastic modulus of bone. Ti-5AI-2.5Fe, Ti-6AI-17 Niobium do not contain relatively toxic V and have a lower elastic modulus. Ti-Ta30 has a thermal expansion modulus similar to ceramic, which reduces the risk of its destruction when combined with metal implants. All titanium alloys are poorly resistant to debris formation. More often they are used for the manufacture of cementless legs, sometimes after surface hardening by oxidation or proton bombardment, and less often - cement ones.

Co-Cr alloys (Co-Cr-Mo, Co-Ni-Cr-Mo, Co-Cr-Ni-W, Co-Ni-Cr-Mo-W-Fe) are highly corrosion resistant, may have some toxicity and immunogenicity due to the presence of nickel. Co-Ni-Cr has poor frictional properties and forms a large amount of debris. Co-Cr-Mo has high hardness and strength, and is used in friction pairs in the manufacture of endoprosthetic heads, as well as in metal-to-metal friction pairs. The latter are characterized by extremely low wear and do not form a large amount of debris, but their use is limited by significant disadvantages: excessive rigidity (partially overcome by installing a metal liner in a polyethylene base), which increases the risk of loosening of the femoral and acetabular components of the endoprosthesis; duration of running-in of rubbing surfaces; increased concentration of metal ions in biological fluids and tissues (toxicity, allergenicity, possibly oncogenicity and teratogenicity); high sensitivity to impingement; risk of osteolytic reactions of bone tissue, high cost. A variant of the metal-to-metal friction pair is the Co-Cr pair with the integration of corundum crystals (Metasul), providing even lower wear.

Zr and Ta alloys have high corrosion resistance, biocompatibility, surface hardness and low debris formation. It is possible to create trabecular metal. True trabecular metal based on tantalum can significantly increase the possibilities of osseointegration, without creating the problem of junction zones of media of different strengths.

The surface of the metal components of endoprostheses can be:

1. polished (heads, cup liners with metal-to-metal friction pairs, cement-fixed legs);
2. rough, which is created by processing in a sand stream (legs and cups of cementless fixation 5-8 microns);
3. porous, which is created by sintering balls or wires (legs and cups of cementless fixation);
4. trabecular, obtained by plasma spraying with metal (cups, as well as cementless fixation stems);
5. coated with hydroxyapatite, calcium phosphate, etc.

The surfaces of the metal components of endoprostheses may not interact with the surrounding tissues, may form a fibrous block, be fixed due to bone adhesion (in the presence of hydroxyapatite-type coatings), as well as due to impaction of the surrounding bone (press-fit) or its ingrowth (rough surface, fibrous and trabecular metal) (Fig. 1).

Rice. 1. Examples of osseointegration of the acetabular and femoral components of the endoprosthesis.

Ceramics

The improvement of ceramic materials has made it possible to consider them as some kind of alternative to metal alloys, and in terms of some of their characteristics, primarily tribological, the ceramic-ceramics pair has unique properties.

From the point of view of interaction with body tissues, ceramic materials can be divided into 3 groups:

• inert ceramics that maintain the shape of the implant and surface structure without tissue ingrowth;
• bioactive ceramics that preserve the shape of the implant and its internal structure with ingrowth of surrounding tissues;
• biodegradable, which loses its shape, surface and internal structure of the implant with ingrowth into it, partial or complete replacement
• damage to surrounding tissues.

When creating endoprostheses, the following types of ceramics are used:

1. Based on oxides of Al, Zr, Ti (Al 2 O 3 ZrO, TiO): bioinert, with high biological compatibility and surface strength, suitable for creating ceramic-polyethylene and ceramic-ceramic friction pairs. Due to the yttrium impurity, zirconium ceramics is characterized by some toxicity.
2. Carbon ceramics (C with different structure, C-Si): bioinert, with good biocompatibility and surface strength. Suitable for covering prosthetic legs and cups, as well as for creating friction pairs.
3. Calcium phosphates and aluminates (Cryst-Ca 5 (PO)3(O), CaAl 2 O 3): bioactive, non-biodegradable. They can provide interaction between bone and other biomaterials, be carriers of medicinal and biologically active substances ( short term action, surface release). Applicable for biomaterial-induced and biomaterial-dependent osseointegration.
4. Calcium sulfates, aluminates and phosphates (CaSO 4, CaAl 2 O 3, Amorph-Ca 5 (PO 4) 3 (OH)): biodegradable, with different replacement periods, can be carriers of medicinal and biologically active substances (long release period). A similar role in the creation of endoprostheses.

The advantages of ceramic friction pairs are high wear resistance and higher surface finish, high bioinertness, and corrosion resistance. Disadvantages: increased rigidity of the ceramic-ceramics pair, a tendency to destruction, including spontaneous destruction due to violation of the production technology or implantation, as well as causticity (especially ceramic-ceramic pairs) (Fig. 2). The appearance of ceramic debris leads to catastrophically increasing wear of the friction pair (both ceramics-polyethylene and ceramics-ceramics), increased formation of destruction products with the induction of osteolysis processes in the bone beds of implants and fibrosis in soft tissues. During revision operations, a separate problem is the impossibility of completely removing the remains of ceramic particles from the primary endoprosthesis, which increase the wear of the already revision friction pair.

Rice. 2. Destruction of the ceramic head of the endoprosthesis.

The feasibility of using bioactive and biodegradable ceramic coatings is debatable. On the one hand, they improve the process of osseointegration and have an osteoconductive effect; on the other hand, when applied in thick layers, complete bone replacement of the ceramics does not occur, and its remains peel off under long-term cyclic loads. metal surface implant, can induce the formation of wear debris and osteolysis.

Polyethylene

There are low-density, medium-low-density, high-density, ultra-high-density and ultra-high-density cross-linked polyethylenes. Polyethylene is used to create a friction pair. Currently, ultra-high-density polyethylene and its derivatives are widely used, usually for the manufacture of the acetabular component. The friction pair metal (head of the endoprosthesis) - polyethylene (cup or liner) is still the reference. To modify ultra-high-density polyethylene in the late 1970s, carbon fibers were used to increase the elastic modulus and wear resistance, reducing the ability to deform (Poly II product, Zimmer). However, application experience has shown a higher frequency of destruction of Poly II elements, including surface ones. This was partly due to poor reproducibility of the manufacturing technology. In the early 90s of the last century, a technology for crystallization of ultra-high density polyethylene without breaking molecular chains and loss of molecular weight (Hylamer, DePuy) appeared, which was characterized by an increase in the strength of the product and its resistance to oxidation.

Sterilization of polyethylene products by high-dose gamma irradiation leads to the occurrence of oxidative reactions in them in the form of two main directions: breaking of molecular chains and formation of cross-links. Moreover, if polyethylene degradation reactions predominate on the surface of the sample, then in depth the level of cross-linking between its molecules increases.

The technology for creating polyethylene with cross-links, which allows for their formation throughout the entire volume of the substance, as well as suppressing degradation reactions, has led to the production of a high-strength and wear-resistant material, which in these parameters approaches metal-to-metal friction pairs, but allows one to avoid such disadvantages of metal joints as hardness, toxicity and allergenicity (due to increased concentrations of cobalt, nickel and chromium ions in the blood). However, the experience of using cross-linked polyethylene has shown that, despite all the promising experimental and first clinical results, there is instability in the production technology of this material, as well as an increased risk of destruction of products made from it under impact loads.

Thus, to date, standard ultra-high density polyethylene remains the most applicable, including with the recrystallization option, and cross-linked polyethylene remains highly promising as new option high-strength friction pair.

Bone cement

Numerous studies have proven that the advantages of cemented prosthetics include the possibility of using simple implant models, the absence of continuous contact of the metal elements of the prosthesis with the bone, the possibility of creating a depot of antibiotics in the operation area, ensuring stable fixation of prosthetic elements in the presence of post-traumatic and dysplastic defects of the bone bed and various osteoporosis genesis.

The main factors that improve the mechanical quality of microadhesion of cement to bone are identified: thorough cleaning of the bone bed before cementing, strength and local regenerative capabilities of the bone, quality of cement mixing, use of a sealed cement supply device. For comprehensive solution To improve the quality of cement fixation, a system of measures has been developed. The main ones are: distal plug of the femoral canal, retrograde filling of the femoral canal with bone cement, drainage of the femoral medullary canal during its filling with cement, formation of holes in the acetabulum for fixation of the acetabular component, vacuum mixing of cement, washing of the cemented bone surface with a pulsating jet (pulsating lavage), cleaning the cemented surface with nylon brushes, dehydration of the bone surface before cementing, pressing the cement when installing the prosthesis. There is information about increasing the efficiency of cementation during centrifugation during the mixing process. High quality of cement preparation, its placement in the bone and uniform distribution of the cement mantle is ensured by a number of developed devices and equipment. These include: vacuum mixers various types, preventing the formation of air bubbles in the cement mass; special syringes for retrograde supply of cement into the cavities, and, above all, into the femoral canal; polyethylene restrictive plugs and guides that form a cement mantle in the femoral canal; finally, devices for pressing or pressing cement into bone pores during its placement. The use of improved cementing technology has reduced the number of revisions regarding infectious complications and implant replacements due to aseptic loosening.

Typically, bone cement consists of two components - a powder (polymer) and a liquid (monomer). Polymer is the main part of bone cement; the main consumer properties of cement depend on its composition. In some types of cement, copolymers are added to polymethyl methacrylate, for example, methacrylate, butyl methacrylate, stearin. Thus, the addition of methacrylate increases the hydrophilicity of cement, increases its flexibility and viscosity. The addition of stearin increases not only the hydrophobicity, but also the fatigue properties of cement. The addition of barium sulfate imparts radiopacity to the cement.

The main brands of cement from various manufacturers and the type of polymer, types of monomer, the ratio of liquid and solid parts of the main brands of bone cement and the maximum temperature of their polymerization are presented in the tables.

Main grades of cement and types of polymer

Temperature and time of polymerization depending on the brand of cement and the percentage of monomer

Cement brand	Monomer	Polymerization temperature	Polymerization time
Boneloc	50% methyl methacrylate 20% isobornimethacrylate 30% n-decyl methacrylate	36°C	11:00
Cemex RX	100% methyl methacrylate	44°С	13:20
Sulfix-6	85% methyl methacrylate 15% butyl methacrylate	48°С	10:50
Palacos R	100% methyl methacrylate	56°С	10:40
CMW3	100% methyl methacrylate	65°C	10:50
Simplex	100% methyl methacrylate	69°С	11:50

When cement is introduced into tissues, both local and general reactions can occur in the body. High temperatures during cement polymerization may be accompanied by damage to the bone in contact with the cement or implant, especially due to denaturation of the protein structures of bone tissue. At a cement mantle temperature of 72°C, bone necrosis occurs almost immediately. A temperature of 60°C causes necrosis after 5 seconds of exposure, 55°C after 30 seconds, and 47°C after 1 minute. Manufacturing companies are looking for ways to reduce the temperature effect on fabrics. General reaction body due to toxic effect cement is a short-term decrease in blood pressure, transient bradycardia. This reaction is more pronounced when using low-viscosity types of cement.

The dosage of mixing components is as follows: 10 ml of liquid component and 20 g of powder, or 20 and 40 ml per 40 and 80 g of powder, respectively. You can mix in an open container with a flat spoon or in a special vacuum mixer. The quality of mixing is better in a mixer, but the polymerization time of cement depends on the ambient temperature and mixing speed.

Cement acquires antimicrobial properties when antibiotics are introduced into it. The most common antibiotic is gentamicin (Polakos, CMW). Tobramycin was added to Simplex cement (England). In recent years, vancomycin has become more frequently added to cement. Independent addition of antibiotic powder to bone cement during surgery is unacceptable, since the chemical structure of the bone cement changes. It is better to increase the dose of antibiotic for intramuscular administration.

Dependence of cement readiness time on ambient temperature

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

Concept endoprosthetics denotes the replacement of a natural joint, destroyed as a result of an accident or natural wear and tear of all or part of the joint, with an artificial one. The new artificial joint is called an endoprosthesis, a prosthetic joint, or a replacement joint. An artificial joint is installed for a long time and partially or completely replaces the damaged natural joint.

The most common reason for joint replacement is arthrosis, i.e. premature or age-related wear of the joint. The cause of arthrosis may be excessive load on the joint, for example, due to overweight or intense sports, congenital or acquired through trauma deformations of the limbs, and the cause may be secondary - due to other diseases (for example, arthritis - inflammation of the joints).

Due to a rapidly aging society, it is almost impossible to imagine operating rooms without joint replacement surgeries. Every year, about 160 thousand hip joint endoprostheses and about 90 thousand knee joint endoprostheses are implanted in Germany.

Arthrosis and other reasons for artificial joint replacement

Thanks to the progress of medicine, it is now possible to replace almost every joint in human body. A rapidly aging society, and a correspondingly growing number of people suffering from arthrosis, has created a huge demand for implantation of artificial joints. However, younger people are also increasingly in need of an artificial joint. The use of improved materials, optimization of operating methods and increased strength of endoprostheses ensure the longevity of artificial joints. Although arthrosis is the most important reason for joint replacement, it is not the only one. The following are some of the main reasons why joint replacement is necessary:

Arthrosis

Arthrosis refers to wear and tear of a joint. In Germany, about 5 million people suffer from this disease. Arthrosis is the most common prerequisite for implantation artificial joint. The cause of arthrosis can be excessive load on the joint, for example, due to excess weight, as well as congenital or acquired deformities of the limbs. Arthrosis is called secondary if it occurs as a result of another disease (for example, arthritis - inflammation of the joint). In fact, arthrosis can affect any joint, but the most common is arthrosis of the knee joint - gonarthrosis). Arthrosis of the hip joint is called coxarthrosis (), and arthrosis of the shoulder joint is called omarthrosis (). Artificial joint replacement is required when it is not possible to cure the joint through medication or other methods.

Incorrect joint position

Incorrect position of the joints (deformation) also provokes arthrosis diseases. So, for example, hip dysplasia - congenital or acquired deformity or disruption of the ossification process of the hip joint - can be the reason for the implantation of an artificial hip joint, and deformation of the knee joint can be the reason for the implantation of an artificial knee joint.

Necrosis

Necrosis is the death of individual cells or parts of tissue in a living organism. Thus, necrosis of the head of the hip joint is the necrosis of part of the bone tissue of the head of the femur, due to impaired blood circulation in it (for example, due to diabetes mellitus, alcoholism or injuries).

Fractures (fractures) and injuries

When joints are fractured, it is sometimes necessary to replace the joint with an artificial one. A typical fracture of this kind is a fracture of the femoral neck, and this fracture occurs near the hip joint and, as a rule, as a result of a fall on the side. However, falls on or blows to the shoulder can cause deformation of the shoulder joint, which may require implantation of an artificial joint.

Tumors and metastases

Whenever bone tumors and metastases (daughter tumors) located on the bone near the joint, severe bone destruction may occur, requiring replacement of the natural joint with an artificial one. For example, metastases of the proximal femur (daughter tumors of the femur near the hip joint) may require hip replacement, and tumors of the proximal humerus (daughter tumors of the humerus near the shoulder joint) may require shoulder replacement.

Arthritis

Arthritis is an inflammatory disease of the joints, on the basis of which arthrosis can develop. If inflammation of several joints is observed, then we are talking about polyarthritis. Chronic polyarthritis, also called rheumatoid arthritis, most often affects the interphalangeal joints, but also the wrist, knee, shoulder and ankle joints. When treating particularly complex forms that do not respond to drug treatment, joint replacement may be required.

Dislocations

Dislocations can be complete or incomplete and imply a violation of the articulation of bones in the joints. So, for example, a hip dislocation is a violation of the articulation of the hip joint. Repeated joint dislocations that cannot be corrected otherwise may require artificial joint implantation.

Joint stiffness

With certain diseases and injuries in the joint area, stiffness of the affected joints occurs - arthrodesis. Due to the low mobility of the joint, it wears out faster (arthrosis) and, as a result, there is a need for implantation of an artificial joint.

Endoprosthetics: materials used and their properties

TO artificial joint many requirements are put forward, for example, they must be resistant to corrosion (should not be subject to changes in the environmental conditions of the human body), biologically compatible (be fully compatible with bone tissue), resistant to increased loads and, if possible, light ones. The materials used today for endoprosthetics in most cases consist of alloys of iron, cobalt and titanium, as well as polyethylene, ceramics and bone cement. To date, it has not yet been possible to invent a lubricant for artificial joints and, depending on the material used and its technological processing, due to friction and movement, wear and weakening of the elements of the endoprosthesis occurs, resulting in the formation of granulomatous tissue and fracture of metal and ceramic components, and Corrosion also occurs. To create endoprostheses with a longer service life without complications, research is continuously carried out in the field of composition of the materials used (for example, wrought alloys or cast alloys), implantation methods (cemented and cementless) and in the field of special surface treatment of endoprostheses.

Cemented and cementless endoprostheses

There are several ways to attach the artificial joint to the remaining bone. Only through the formation of new bone tissue can reliable fastening of the joint prosthesis be ensured. To speed up this process and improve the accuracy of implantation of the prosthesis, it is attached to the bone using bone cement. Such endoprostheses are called cement ones. Endoprostheses can also be implanted without bone cement and are accordingly called cementless. There is also a combination of these two methods, for example, one part of the artificial joint is attached with cement (for example, a prosthesis for the acetabulum), and the other part without cement (for example, the prosthesis shaft). They are called hybrid (combined) endoprostheses.

Hip replacement - artificial hip joint (hip arthroplasty)

Sometimes there is a need to implant an artificial hip joint after serious pathological changes in him. Frequent and most known cause arthrosis, which provokes wear and tear of the joint. Along with arthrosis, there are many other congenital and acquired diseases, as well as the consequences of injuries, which lead to premature wear of the joints and, therefore, to arthrosis.

The ends of the hip joint of a healthy person who does not have arthrosis are covered with hyaline cartilage, which forms a smooth surface and provides better gliding. Firstly, arthrosis causes the formation of crystals uric acid, and secondly, it causes cartilage degeneration. Because of this, smooth, soft joint contact is disrupted. Next, changes occur in the acetabulum and head of the femur, which, when they come into contact, lead to a decrease in the cartilaginous layer. This leads to pain during exertion (for example, during even short walking) and then also at rest. There are non-surgical treatment methods, but if it is not possible to eliminate the pain and restore joint mobility, you need to think about implanting a hip joint endoprosthesis in order to improve the quality of life.

At hip replacement There are single-pole endoprostheses and total endoprostheses (TEP). Unipolar hip replacement involves only replacing the femoral neck and femoral head, while the acetabulum remains natural; With total endoprosthetics, both the femoral neck with the head of the femur and the acetabulum are replaced. When using cemented arthroplasty, the stem and acetabulum of the artificial joint are attached to the bone using bone cement. If cementless arthroplasty is used, the artificial joint grows into the bone without the use of bone cement.

Knee replacement - artificial knee joint (knee replacement)

Along with arthrosis, there are other reasons that cause excessive wear of hyaline cartilage. These include improper loading due to leg deformities (o-shaped and x-shaped legs), as well as previously acquired injuries or inflammation of the knee joint. When cartilage surfaces rub against each other, degeneration of cartilage tissue occurs over time. This exposes the bone and causes pain when moving. Then the pain becomes stronger.

Destroyed joint components can be replaced with artificial ones. Depending on the degree of destruction of the knee joint caused by arthrosis, three types of knee joint endoprostheses are distinguished: unilateral surface replacement (unicondylar prosthesis) is used when arthrosis has destroyed only one half of the joint, and the remaining components of the joint (ligaments, the other half of the joint, patella) are still performing their functions. This surgery is often performed in a minimally invasive manner. An endoprosthesis with a movable platform (complete surface replacement) is necessary when arthrosis has destroyed several components of the joint (eg, cartilage and cruciate ligament); however, the condition is the functioning of the collateral ligaments. A connected endoprosthesis is necessary when arthrosis has destroyed the entire knee joint, along with hyaline cartilage and ligaments, or when there is valgus and varus deformity of the legs (deviation from the conventional line drawn through the first space between the toes, the middle of the knee and the hip joint).

Complications after endoprosthetics

Patients with implanted artificial joints should undergo regular clinical examinations (eg, redness or swelling of the skin, dysfunction of the endoprosthesis) and radiography in order to detect early complications or changes in the bone or artificial joint. Such changes may be an osteolytic lesion, a fracture, symptoms of wear and weakening of the elements of the endoprosthesis. Complications can occur during implantation of the endoprosthesis (intraoperative complications) and after the operation (postoperative complications), and they can occur either within a short period of time after the operation or after a longer period of time.

Infections

Infection at the endoprosthetic site is the biggest concern in endoprosthetics. Infections should be taken very seriously because... in the worst case, they can lead to the loss of the endoprosthesis because infections cause weakening of its elements. If there is early infection, i.e. during the first year after endoprosthetics, the reason is insufficient sterility of the operating room or subsequent infection of the surgical wound. Late infection in most cases is caused by infectious diseases. External signs of infection in the area of ​​the endoprosthesis include swelling, redness, increased body temperature, pain and secretions.

Intraoperative complications

All surgery carries risks, and artificial joint implantation carries particular risks. These include, for example, damage to blood vessels, nerve damage, fractures, disruption of rod threads and perforations (holes for attaching the endoprosthesis), dislocations and deformations (due to incorrect positioning), incorrect leg length (when replacing a hip joint), weakening elements of the prosthesis (due to insufficient fixation) or instability. Caution during surgery in most cases avoids these complications.

Postoperative complications

Along with thrombosis, embolism, bedsores and unsatisfactory general condition, after endoprosthetics, swelling may occur (with fluid accumulation and poor wound healing), hematomas and re-bleeding, dislocations (sometimes during the first attempts to move due to weakened muscles), stiffness (for example, after knee replacement due to slow movement or after hip replacement due to calcification).

Late infections

So-called stress fractures, i.e. Damage to endoprostheses due to metal fatigue is rare. The materials used today for the manufacture of endoprostheses, as well as the techniques used for their implantation, almost completely eliminate the risk of stress fractures. It is more likely to expect a fracture of the femoral diaphysis during endoprosthesis replacement of the hip joint (unipolar hip endoprosthesis) or knee joint (unipolar knee endoprosthesis) in the area of ​​the artificial joint or under the endoprosthesis. In adulthood, osteoporosis is to blame. Enough common problem- this is a weakening of the components of an artificial joint, which can occur as early as 10-15 years after implantation of the endoprosthesis, due to excessive load on him. The artificial joint loses its reliable attachment to the bone and this leads to instability.

Surgical methods of endoprosthetics

Artificial joint implantation surgery It is performed under local (spinal) or general anesthesia. The patient does not experience pain with any of the anesthesia methods. Depending on which joint is to be replaced and which implantation method is chosen, the operation can last from 45 to 120 minutes. It is possible to replace some joints using a minimally invasive method.

Hip replacement surgery

After making an incision in the skin, the surgeon moves the muscles to the side and thus creates access to the hip joint. Next, after dividing the femoral neck and the destroyed head of the hip joint, the acetabulum is processed with a spherical cutter. The new, artificial acetabulum is secured in the milled cavity. To accurately fit the new artificial endoprosthesis socket, careful preparation of the bone marrow area of ​​the femur is required. When the endoprosthesis head is properly inserted into the endoprosthesis socket, both of these components form an artificial joint. At the end of this procedure, surgeons suture the muscles and close the wound.

Knee replacement surgery

Typically the knee joint is approached from the front. By moving the kneecap to the side, surgeons have an excellent view of the entire knee joint. Depending on the degree of destruction of the knee joint caused by arthrosis, the destroyed parts of the bone and cartilage, as well as the meniscus, are removed. Using pre-prepared templates, the bone is processed in such a way that the elements of the artificial joint fit exactly where they will be implanted. After proper installation of the endoprosthesis and checking its mobility, it is fixed to the bone. After these procedures, the wound closes again.

Postoperative care

The decisive factor for the success of the operation and the longevity of the artificial joint is post-operative care and patient behavior. The physical therapist helps the patient begin to “use” the joint and resume daily activities independently. To identify in advance possible complications that may develop slowly and unnoticed by the patient, regular monitoring by the attending physician is necessary. Depending on the operation and the age of the patient, visits to the doctor may be scheduled more often or less frequently.