Hip joints hurt after arthroplasty. Complications after hip replacement

The whole truth about: pain after arthroplasty hip joint and other interesting information about the treatment.

Studies show that complications after hip arthroplasty develop in 1% of young people and 2.5% of older patients. Despite the meager likelihood of developing negative consequences, they can affect anyone, and especially those who did not strictly follow the rehabilitation program.

Image of the position of the endoprosthesis in the human body.

Complications after hip arthroplasty are caused by improper postoperative care and physical activity regimen after discharge from the hospital. The second reason is the mistakes of the surgeon. And third, this is an inferior preoperative examination, as a result of which latent infections (tonsils, cystitis, etc.) were not cured. The success of treatment is affected by the qualifications of the medical staff, where the patient received high-tech medical care - surgical and rehabilitation treatment.

The pain is different, there is a "good" - after moderate physical exertion. And there is a “bad” one, talking about problems that need to be urgently diagnosed.

The operation to install a hip prosthesis is the only method that "puts" the patient on his feet, relieves debilitating pain and limited ability to work, and allows you to return to healthy physical activity. Unpleasant pathological situations associated with implantation occur infrequently, about which the patient should be informed. According to ongoing randomized controlled trials, the following data were obtained:

• dislocation of the head of the prosthesis develops in approximately 1.9% of cases;
• septic pathogenesis - in 1.37%;
• thromboembolism– in 0.3%;
• periprosthetic fracture occurs in 0.2% of cases.

They develop not through the fault of the surgeon, but the patient himself, who did not continue rehabilitation or did not adhere to a special physical regime after the end of recovery. The deterioration of the condition occurs already at home, when there is no that careful control by the doctors that was in the clinic.

If you have had an operation, enough time has passed, but the leg cannot repeat the amplitude of movement of a healthy limb, then this is the result of a lack of rehabilitation.

Not a single orthopedic specialist, even with rich and impeccable work experience, can 100% predict how a particular organism will behave after such complex manipulations on the musculoskeletal system, and give the patient a complete guarantee that everything will go smoothly and without excesses.

Differentiation of pain: normal or not

Pain after hip arthroplasty will be observed in the early period, because the body has experienced a serious orthopedic operation. Painful syndrome during the first 2-3 weeks is a natural response of the body to a recent surgical injury, which is not considered a deviation.

Until the surgical injury heals, the muscle structures do not return to normal, until the bones, together with the endoprosthesis, become a single kinematic link, the person will experience discomfort for some time. Therefore, a good pain reliever is prescribed, which helps and makes it easier to endure early painful symptoms, and it is better to concentrate on treatment and rehabilitation classes.

Well healing suture after surgery. It is even, pale and has no discharge.

Pain sensations should be differentiated and examined: which of them is the norm, and which is a real threat. This can be done by the operating surgeon. The task of the patient is to notify the orthopedist in case of any uncomfortable signs.

Main Risk Factors

Surgical intervention does not exclude complications, and serious ones. Especially if mistakes were made in the intra- and / or post-operative period. Even small errors during surgery or during rehabilitation increase the likelihood of unsatisfactory hip arthroplasty. There are also risk factors that increase the body's predisposition to postoperative consequences and often become their cause:

• advanced age of a person;
• severe comorbidity, such as diabetes, arthritis of rheumatoid etiology, psoriasis, lupus erythematosus;
• any previous surgical intervention on the "native" joint, aimed at the treatment of dysplasia, femoral fractures, coxarthrosis deformities (osteosynthesis, osteotomy, etc.);
• re-endoprosthetics, that is, repeated replacement of the hip joint;
• local inflammation and purulent foci in the patient's history.

It should be noted that after the replacement of the hip joints, older people, and especially those over 60, are more susceptible to complications. In addition to the underlying disease, older patients have comorbidities that can complicate the course of rehabilitation, for example, reduce resistance to infection. There is a reduced potential for reparative and restorative functions, weakness of the musculo-ligamentous system, osteoporotic signs, and lymphovenous insufficiency of the lower extremities.

It is more difficult for older people to recover, but this is also done successfully.

The concept and methods of treating the consequences

Symptoms of complications after hip arthroplasty for better perception will be presented in the table below. A quick visit to the doctor at the first suspicious signs will help to avoid the progression of adverse events, and in some situations, save the implant without revision surgery. The more neglected the clinical picture becomes, the more difficult it will be for therapeutic correction.

Dislocations and subluxations of the endoprosthesis

Negative kurtosis occurs in the first year after prosthetics. This is the most common pathological condition, at which the femoral component is displaced in relation to the acetabular element, as a result of which there is a separation of the head and cup of the endoprosthesis. The provocative factor excessive loads, errors in the selection of the model and installation of the implant (defects in the angle of setting), the use of posterior surgical access, injuries.

Dislocation of the femoral component on x-ray.

The risk group includes people with hip fractures, dysplasia, neuromuscular pathologies, obesity, joint hypermobility, Ehlers syndrome, patients over 60 years of age. Also particularly vulnerable to dislocation are individuals who have undergone surgery on a natural hip joint in the past. The dislocation needs non-surgical reduction or an open method. With timely treatment, it is possible to set the endoprosthesis head in a closed way under anesthesia. If you start the problem, perhaps the doctor will prescribe reoperation in order to reinstall the endoprosthesis.

paraprosthetic infection

The second most common phenomenon, characterized by the activation of severe purulent-inflammatory processes in the area of ​​the implant. Infectious antigens are introduced intraoperatively through insufficiently sterile surgical instruments (rarely) or, after intervention, they move along the bloodstream from any problematic organ that has a pathogenic microbial environment (often). Poor treatment of the wound area or poor healing (in diabetes) also contributes to the development and reproduction of bacteria.

Discharges from operating wound this is a bad signal.

The purulent focus adversely affects the strength of the fixation of the endoprosthesis, causing it to loosen and become unstable. Pyogenic microflora is difficult to treat and, as a rule, involves the removal of the implant and re-installation after a long time. The main principle of treatment is a test to determine the type of infection, long antibiotic therapy, abundant wound lavage with antiseptic solutions.

The arrows indicate the zones of infectious inflammation, this is how they look on the X-ray.

Thromboembolism (TELA)

PE is a critical blockage of the branches or main trunk of the pulmonary artery by a detached thrombus, which was formed after implantation in the deep veins of the lower limb due to low blood circulation resulting from limited leg mobility. The culprits of thrombosis are the lack of early rehabilitation and the necessary medical treatment, a long stay in an immobilized state.

With this complication, they are quite successfully working at this stage of the development of medicine.

The blockage of the lumen of the lungs is dangerously fatal, so the patient is immediately hospitalized in the intensive care unit, where, given the severity of the thrombotic syndrome: the introduction of thrombolytics and drugs that reduce blood clotting, NMS and mechanical ventilation, embolectomy, etc.

Periprosthetic fracture

This is a violation of the integrity of the femur in the area of ​​the leg with an unstable and stable prosthesis, which occurs intraoperatively or at any time after surgery (after a few days, months or years). Fractures more often occur due to reduced bone density, but may be the result of incompetent development of the bone canal before installing an artificial joint, an incorrectly chosen method of fixation. Therapy, depending on the type and severity of damage, consists in using one of the methods of osteosynthesis. The leg, if necessary, is replaced with a more suitable configuration.

Implant failure is very rare.

neuropathy

The neuropathic syndrome is peroneal nerve included in the structure of a large sciatic nerve, which can be provoked by lengthening of the leg after prosthetics, pressure of the resulting hematoma on nerve formation, less often - intraoperative damage due to careless actions of the surgeon. Restoration of the nerve is carried out through etiological treatment with the optimal method of surgery or through physical rehabilitation.

When working with an inexperienced surgeon, there is a risk of injury to the femoral nerves.

Symptoms in the table

Syndrome	Symptoms
Dislocation (violation of congruence) of the prosthesis	paroxysmal pain, muscle spasms in TBS, aggravated by movements; in a static position, the severity of pain is not so intense; forced specific position of the entire lower limb; over time, shortening of the leg occurs, lameness appears.
Local infectious process	Severe pain, swelling, redness and hyperthermia of soft tissues over the joint, discharge of exudate from the wound; an increase in the general body temperature, the inability to step on the foot due to pain, impaired motor functions; purulent discharge from the wound, up to the formation of a fistula, is observed in advanced forms.
Thrombosis and PE (thromboembolism)	Venous congestion in a diseased limb can be asymptomatic, which may have an unpredictable detachment of a blood clot; with thrombosis in varying severity, edema of the limb, a feeling of fullness and heaviness can be traced, drawing pains in the leg (intensify with load or change of position); PE is accompanied by shortness of breath, general weakness, loss of consciousness, and in the critical phase - blueness of the skin of the body, suffocation, up to death.
Periprosthetic bone fracture	Acute pain attack, rapidly growing local edema, redness of the skin; crunching when walking or probing the problem area; severe pain when moving with an axial load, soreness of soft structures on palpation; deformity of the leg and smoothness of the anatomical landmarks of the hip joint; impossibility of active movements.
Neuropathy of the tibial nerve	numbness of the limb in the area of ​​​​the thigh or foot; weakness of the ankle (drop foot syndrome); inhibition of motor activity of the foot and toes of the operated leg; the nature, intensity and location of pain can be variable.

Preventive measures

Complications after hip replacement are much easier to prevent than to deal with time-consuming and lengthy treatment to get rid of them. An unsatisfactory development of the situation can nullify all the efforts of the surgeon. Therapy doesn't always work positive effect and the expected result, therefore, leading clinics provide a comprehensive perioperative program for the prevention of all existing consequences.

Infections are treated with antibiotics, which in itself is quite harmful to the body.

At the preoperative stage, diagnostics are performed for infections in the body, diseases of internal organs, allergies, etc. If inflammatory and infectious processes, chronic diseases in the decompensation stage are detected, surgical measures will not begin until the identified foci of infections are cured, venous-vascular problems will not be reduced to an acceptable level, and other ailments will not lead to a state of stable remission.

Currently, almost all implants are made of hypoallergenic materials.

If there is a predisposition to allergic reactions, this fact is investigated and taken into account, since the choice of medicines, endoprosthesis materials and the type of anesthesia depends on it. The entire surgical process and further rehabilitation are based on the assessment of the state of health of internal organs and systems, age criteria and weight. In order to minimize the risks of complications after hip replacement to the limit, prophylaxis is carried out before and during the procedure, after surgery, including the long-term period. Comprehensive preventive approach:

• drug elimination of the infectious source, full compensation of chronic ailments;
• appointment for 12 hours of certain doses of low molecular weight heparins to prevent thrombotic events, antithrombotic therapy continues for some time after surgery;
• application a couple of hours before the upcoming TBS replacement and for several days of antibiotics a wide range actions active against a wide group of pathogens;
• technically impeccable surgical intervention, while with minimal trauma, preventing significant blood loss and the appearance of hematomas;
• selection of an ideal prosthesis design that fully matches the anatomical parameters of a real bone joint, including its correct fixation at the correct orientation angle, which in the future guarantees the stability of the implant, its integrity and excellent functionality;
• early activation of the ward in order to prevent stagnant processes in the leg, muscle atrophy and contractures, inclusion from the first day of exercise therapy and physiotherapy procedures (electromyostimulation, magnetotherapy, etc.), breathing exercises, as well as high-quality care for the surgical wound;
• informing the patient about all possible complications, permitted and unacceptable types of physical activity, precautions and the need to regularly perform physical therapy exercises.

A huge role in successful treatment is played by communication between the patient and the medical staff. This is what is called a service, because when a patient is fully instructed, he better perceives the processes taking place with his body.

The patient must be aware that the outcome of the operation and the success of recovery depend not only on the degree of professionalism of the doctors, but also on himself. After prosthetics of the hip joint, it is possible to bypass unwanted complications, but only with the impeccable observance of the recommendations of specialists.

The pathology of one or another element of the musculoskeletal system leads a person to a constant feeling of pain, loss of working capacity and quality of life. Often this occurs due to damage to the hip joint.

This element of the human skeleton bears a huge load on the entire body, is involved in the function of walking, but at the same time is quite vulnerable to various diseases.

Why does the hip joint hurt? What to do if symptoms occur? Which doctor should I go to with such a pathology? How to relieve pain yourself? We will try to answer these and other questions.

Causes of pain syndrome

The hip joint can be affected by various diseases. At the same time, patients complain of a variety of symptoms: pain, stiffness, limited mobility, swelling, a feeling of clicking in the joint.

The most common causes of hip pain are:

• Deforming osteoarthritis.
• Rheumatoid arthritis.
• Gouty arthritis.
• Ankylosing spondylitis.
• reactive arthritis.
• infectious arthritis.
• Injuries and fractures.
• Diseases of the soft tissues surrounding the joint.

Cause pain in the hip joint can be other more rare diseases: systemic diseases connective tissue, vascular thrombosis, bone tumors and metastases from other organs. However, after contacting a doctor, the specialist will first rule out the most common causes of joint damage.

Hip joints can disturb a person, even if there is no direct pathology in the joint.

This condition occurs with radiculopathy and osteochondrosis. Pinching the nerve root leads to the fact that the pain radiates to the buttocks, hip joint and lower limb. However, in this case, the pathology will be accompanied by back pain and other symptoms of osteochondrosis.

It is worth analyzing the most common causes of pain in the joint.

arthrosis

Deforming osteoarthritis is the most common disease of the hip joint. This disease is characterized by degeneration of cartilage, the bones that form the joint, and the development of chronic inflammation.

The body tries to compensate for the condition, which causes bone outgrowths - osteophytes. This further exacerbates the clinical picture of the disease.

Characteristic signs of the disease:

1. Patients are over 40 years of age.
2. Injuries, sports loads on the joint in the past.
3. Pain after exercise, worse in the evening.
4. Pain in the hip joint when walking.
5. Restriction of mobility.
6. At night, the pain in the hip joint weakens or does not bother at all.
7. Morning stiffness is not typical.
8. Pain when resting on one leg.
9. External deformities of the joint are difficult to detect due to the powerful muscular skeleton of the thigh.

The described symptoms are quite characteristic, it is usually not difficult to make a diagnosis.

Osteoarthritis is a chronic and progressive disease. Completely eliminate the damage can only be with the help of surgical intervention.

Other methods are able to eliminate symptoms and prevent the progression of the disease. Treatment options will be discussed below.

Rheumatoid arthritis

The hip joint is often affected in rheumatic (autoimmune) diseases. One of them is rheumatoid arthritis. This disease is characterized by the formation of antibodies to the body's own tissues. Antibodies attack the internal organs and joints, which leads to the development of inflammation.

Diseases can be suspected with a combination of the following signs:

1. More often the debut occurs at a young age.
2. Women get sick more often than men.
3. Weight loss.
4. There are previous frequent viral diseases.
5. Pain in the hip joint occurs in the morning or at night, at night the symptoms often cause the patient to wake up.
6. The joints of the hand, feet, and knee joints are also affected.
7. There is morning stiffness for more than 20-30 minutes.
8. The pain does not go away at rest, but, on the contrary, increases.
9. Symmetrical lesion of the joints.
10. The defeat of the musculoskeletal system is combined with the pathology of the internal organs.

Rheumatoid arthritis in modern conditions is quite well amenable to drug control. The main factor for successful treatment is the detection of the disease at an early stage.

If the symptoms described above occur in one or more joints, you should consult a doctor.

The hip joint is rarely affected first, but in the course of the disease it is often involved in the pathological process.

Gout

The hip joint can become inflamed with gout. This metabolic disease is due to the fact that the level of uric acid in the body rises. Salts of this substance in the form of crystals settle in the subcutaneous tissue and joints, which leads to an inflammatory reaction.

Signs to suspect the disease:

1. Male gender and age over 40 years.
2. Frequent consumption of meat, legumes, alcoholic beverages.
3. Availability subcutaneous formations- tophi.
4. Attacks of pain in the joints occur abruptly, lasting several days.
5. In the interictal period, nothing bothers a person.
6. Found in blood high level uric acid.
7. The pain intensifies with exertion, attempting active movements.
8. The joint swells, becomes sharply painful, the local temperature rises.

A huge role in the treatment of the disease is a change in lifestyle. The main treatment is diet. The patient should limit the consumption of meat products and alcohol (especially beer).

The doctor prescribes treatment to maintain the level of uric acid and relieve pain during an exacerbation.

Ankylosing spondylitis

Another autoimmune disease is ankylosing spondylitis (Bekhterev's disease). With this pathology, two variants of the course of the disease are possible:

• The central form - the spine and sacroiliac joints are affected.
• Peripheral form - arthritis of the hip or knee joints joins the lesion of the spine.

The hip joint can hurt with this pathology, not only due to local inflammation, but also because of the increasing load. With Bechterew's disease, the depreciation ability of the spine is lost, the function of the pelvic joints is impaired.

Features of the clinical picture:

1. Simultaneous damage to the joints and spine.
2. Male gender.
3. Age about 40 at the onset of the disease.
4. Pain of an inflammatory nature - at night and in the morning, after a long immobile position.
5. Progressive decrease in mobility of both the joints and the spine. At the end of the disease, the vertebrae fuse into a single fixed structure.
6. More often symmetrical damage to the joints.
7. Pain when resting on one leg.

Ankylosing spondylitis is difficult to treat and control symptoms. The earlier treatment is started, the longer it is possible to preserve the function of the musculoskeletal system.

Reactive and infectious arthritis

Hip pain can be due to arthritis. This term is called the inflammatory process in the area of ​​the articular bag. With arthritis, the production of intra-articular fluid increases, edema occurs, which compresses the cartilage and nerve endings, which causes severe pain.

After infections of other organs, often the urinary system, the body produces antibodies to pathogenic microorganisms. These proteins penetrate the leg, namely into the tissues of the joints, where they can cause reactive arthritis. After a few weeks, this condition goes away on its own. Reactive arthritis should only be treated symptomatically.

The causes of infectious arthritis are different. A pathogenic microbe directly enters the joint and causes an inflammatory reaction. The inflammation is of a purulent nature and is characterized by severe pain, the inability to stand on one affected leg, a temperature reaction, and severe swelling.

In the latter case, it is necessary to treat the pathology with the use of antibiotics. What to do if such symptoms occur? Rather see a doctor. Purulent arthritis very dangerous disease.

Injuries

The causes of pain in the hip joint are often injuries and damage to the bones that make up the joint. The most common of these is a fracture of the femoral neck.

If a person has fallen, received a direct blow to the joint area, or has been in a traffic accident before the onset of symptoms, the causes of pain become almost obvious.

Fracture signs:

1. Severe pain immediately after injury.
2. Impossibility of active movements in the joint.
3. Severe soreness with passive movements.
4. Feeling of crunch, clicks in the joint.
5. Inability to stand up.

The doctor will detect additional signs when examining the patient, and confirm the diagnosis with an x-ray.

The risk of fracture increases in older age, in menopausal women, and in the presence of osteoporosis (decrease in bone mineral density).

What to do after an injury? It is necessary to call an ambulance as soon as possible. Take the pain off initial stage analgesics and a cold compress will allow. Pathology can be treated by various methods, the choice rests with the attending physician.

Soft tissue lesions

Very often, pain in the area of ​​the hip joint does not arise from a direct lesion of the joint capsule, but from the pathology of the soft tissues around it.

This anatomical region has a large number of ligaments, muscles and tendons of the leg, which can withstand severe stress.

Soft tissue lesions have the following names: tendinosis and tendonitis, myositis, enthesopathy. All these diseases are characterized by a reversible inflammatory lesion.

Signs of soft tissue diseases:

1. Pain after intense exercise or injury.
2. The symptoms subside and go away with rest.
3. Local pain and swelling is determined.
4. The duration of symptoms is several weeks.
5. The lesion is often asymmetrical.
6. On X-ray examination, there is no pathology of the joint.
7. Blood tests without pathology.

Soft tissue diseases have a benign course. Pain and other signs go away on their own, only symptomatic drugs are used in the treatment.

Often, to eliminate the recurrence of the disease, it is required to limit physical activity or wear special bandage devices.

Diagnosis of diseases

To make a correct diagnosis, the doctor will begin the examination of the patient with a comprehensive survey and clarification of complaints. After that, an objective, comprehensive examination and examination of all affected joints is performed.

Further diagnostics is based on the use of laboratory and instrumental techniques. Laboratory tests:

• General blood analysis.
• General urine analysis.
• Biochemical study of blood.
• Examination of joint fluid.
• Immunogram.
• Serological analyses.
• Polymerase chain reaction in the presence of an infectious mechanism of development.

Instrumental methods for examining the hip joint:

• X-ray examination in several projections.
• X-ray contrast study.
• Ultrasound diagnostics.
• Magnetic resonance imaging.
• CT scan.
• Arthroscopy is the introduction of a camera into the joint cavity.

Of course, not all research has to be done in a particular clinical situation. Usually, the doctor begins to suspect a certain pathology already at the stage of the survey, and conducts research to clarify the diagnosis and determine the stage of the process.

Diagnostic results may influence the choice of therapy. The radiological stage of arthrosis, in particular, can be a criterion for prescribing surgical treatment.

Treatment

What to do if you experience vague pain in the hip joint? The first step is to contact the local therapist. The doctor will make a preliminary diagnosis and refer the patient to narrow specialists.

Most of the diseases of the musculoskeletal system indicated above are treated by a rheumatologist. If a fracture or other injury occurs, you should consult with a traumatologist. Surgeons and orthopedists advise on the surgical correction of pathology. If the spine and peripheral nerves are involved in the process, a consultation with a neurologist will be required.

Whichever doctor treats the hip joint, he will use A complex approach in therapy. This means that several methods will be applied at once to eliminate symptoms and prevent progression:

1. The impact of drugs.
2. Physiotherapy.
3. Massage and exercise therapy.
4. Therapeutic immobilization.
5. Surgical correction.

Not all diseases can be cured once and for all, but effective methods of control have been developed for most. Following the recommendations of a specialist will allow you to successfully fight the disease.

Medical treatment

Depending on the cause of the disease, the doctor will prescribe various drug therapy. It will be selected to eliminate symptoms and prevent progression. The means used are:

• Non-steroidal anti-inflammatory drugs. Reduce the intensity of inflammation.
• Muscle relaxants. Relax spasmodic muscles around the joint.
• Analgesics. Eliminate pain by acting on nerve receptors.
• Hormonal preparations. They are used in the form of gels or intra-articular injections, they have a pronounced anti-inflammatory effect.
• Vitamins. Promote proper metabolism and absorption of substances.
• Calcium preparations and other elements. Compensate for the lack of trace elements in the body.
• Genetically engineered biological preparations. Modern group for treatment rheumatic diseases.
• Irritant ointments. They act on nerve endings, have a desensitizing effect.

For the treatment of gout, drugs are used that reduce the level of uric acid in the blood. If an infection is present, antibiotics are used. In the treatment of rheumatic diseases, cytostatics may be required.

The patient must strictly adhere to the prescribed dosages of drugs in order to achieve the elimination of symptoms from the hip joint.

Physiotherapy treatment

In the treatment of pathology of the hip joint, physiotherapy techniques can be used. These therapeutic procedures have been developed for a long time and have proven to be an excellent symptomatic remedy.

Physiotherapy helps to relieve the symptoms of inflammation, improve microcirculation. The procedures alleviate the condition of patients, relieve swelling in the area of ​​the affected joint.

Physiotherapy options include:

1. Magnetotherapy.
2. Electro- and phonophoresis.
3. Mud treatment.
4. Balneotherapy.
5. Electroneurostimulation.
6. Paraffin applications.
7. Ultraviolet irradiation.

Not with any disease, physiotherapy can be used. Warming techniques are contraindicated in the infectious process. In addition, it is impossible to apply physiotherapy in the presence of cardiovascular insufficiency, diseases nervous system, pathology of the kidneys and liver, some diseases of the blood system, oncological processes.

Helper Methods

It is impossible to achieve a pronounced effect from the therapy without performing physiotherapy exercises. Strengthening exercises are indicated for all patients with articular pathology. It is necessary to perform a complex of gymnastics exercise therapy for 20-30 minutes a day with a gradual increase in load. In addition, swimming and Nordic walking, yoga, skiing will be useful.

After doing the exercises, you can relax tense muscle tissues with the help of massage sessions. This method not only relieves symptoms, but also improves the overall well-being of the patient. Massage relieves swelling and inflammation, prevents atrophy of muscle fibers.

Orthopedic constructions are widely used among patients with pathology of the hip joint. The attending physician and consultant in the orthopedic salon will help you choose the device that suits you.

Surgery

If conservative treatment fails, surgical correction of the joint should be considered.

During the operation, damaged tissues can be removed and replaced with prosthetic structures. Hip arthroplasty in modern orthopedic practice is a common and widely performed operation. There are several options for intervention, the choice between which depends on the severity of the disease and the age of the patient.

After the surgical replacement of the joint, it is required to undergo a rehabilitation course. Recovery includes exercise, the use of bandages and orthoses, and medical management of symptoms.

The speed of tissue healing and elimination of symptoms depends on the implementation of the recommendations of the attending physician.

Treatment with folk remedies

Many patients still widely practice the use of folk recipes for the treatment of pain in the hip joint. Compresses, decoctions, homemade ointments are not recommended for use without consulting a specialist.

It is not known exactly how the folk remedy will affect the pathological process, in addition, it is necessary to take into account the cause of the disease and the individual characteristics of the patient.

Before using any method of treatment, consult your doctor.

Pain after hip arthroplasty: causes and treatment

Hip arthroplasty is the replacement of a damaged joint element with an artificial implant.

Such an operation is prescribed for various reasons, it can be complex diseases of the hip joint or its injuries.

After arthroplasty, the patient must follow certain recommendations.

Indications for prosthetics

Most often, arthroplasty is prescribed in the following situations:

1. Trauma to the femoral neck (usually fractures).
2. Severe, advanced stages of rheumatoid arthritis.
3. The presence of aseptic necrosis of the head (avascular necrosis).
4. development of hip dysplasia.
5. Severe stages of coxarthrosis.

The need for an implant may arise as a result of post-traumatic complications, such as arthrosis. The patient's life after arthroplasty changes, as a number of recommendations appear that must be strictly followed.

There are some restrictions, the patient must perform a complex of special physiotherapy exercises. At first, the patient is forced to use crutches.

The duration of the postoperative period and full recovery entirely depend on the general condition of the patient, his age and numerous other factors. In order to avoid possible complications from hip arthroplasty, the patient must be disciplined in following the recommendations of the attending physician.

The complex of therapeutic exercises, which is necessary for the restoration of the hip joint, must be performed under the supervision of an instructor with a medical qualification. Life in the new mode will bring the moment of full recovery much closer, thanks to which the patient will be able to start walking much faster without the help of crutches. It can also be noted that rehabilitation after hip arthroplasty can continue at home.

After endoprosthetics, pain, as a rule, is pronounced. It is strictly forbidden to take any measures on your own, otherwise you can get serious complications.

The main indications for endoprosthesis surgery are the symptoms that accompany the disease and the results of clinical and radiological studies. The symptoms indicated by the patient are the most significant factor that is an indication for surgery.

In some situations, despite the fact that coxarthrosis is in the last stage of its development (this is clearly demonstrated x-ray examination), the person is not bothered by pain and other symptoms of the disease. This pathology does not require surgical intervention.

Modern hip endoprosthesis - its features

Modern orthopedics in its development has greatly succeeded. A feature of today's endoprosthesis is a complex technical structure. The prosthesis, which is fixed in the bone without cement, consists of the following elements:

• leg;
• a cup;
• head;
• insert.

The endoprosthesis, which is fixed with cement, differs from the previous one in the integrity of the acetabular element.

Each component of the implant has its own parameters, so the doctor must determine the size that is ideal for a particular patient.

Endoprostheses differ from one another in the way of fixation. Exists:

1. Cement fixation.
2. The fixation is cementless.
3. Combined fixation (a hybrid of the first two).

Since reviews of different types of endoprosthesis are mixed, it is necessary to collect as much information about the implant as possible before hip replacement surgery.

The endoprosthesis can be unipolar or total. The use of one or another artificial joint depends on the number of elements that need to be replaced. The implementation of interaction in the endoprosthesis is called "friction pair".

How long an artificial hip joint implant can serve depends entirely on the quality of the material from which the endoprosthesis is made.

How is arthroplasty performed?

The process of hip replacement is performed by two teams - anesthesia and operating room. The operating room team is led by a highly qualified practicing surgeon. In the photo you can see the place where the doctor makes an incision to remove and replace the joint.

The duration of the hip arthroplasty operation lasts on average 1.5-2 hours. The patient at this time is under anesthesia or spinal anesthesia, so he does not feel pain. To rule out infectious complications, intravenous administration antibiotics.

After arthroplasty, the patient remains in the intensive care unit for some time, under constant medical supervision. Over the next seven days, the patient continues to receive drugs that prevent blood clotting and antibiotics.

In order to maintain a certain distance between the legs, a pillow is placed between them. The patient's legs should be in the retracted position.

Body temperature after hip arthroplasty is often unstable. For some time the patient feels pain, so he is given anesthetics.

It is impossible to predict in advance how long the recovery period after arthroplasty will take. In order for the rehabilitation process to go much faster, the patient must be disciplined and must follow all the recommendations of the attending physician.

Recommendations to be followed for the rest of your life
The patient should start moving the very next day. And this is done without getting out of bed. Right on the bed, the patient can move and perform therapeutic exercises.

To fully restore mobility in the hip joint, it is necessary to constantly work on its development. In addition to the course of physiotherapy exercises, the patient is shown breathing exercises.

Most often, the patient can walk already on the third day of rehabilitation, but he must use crutches. After a few days, doctors will remove the stitches. After the operation to implant an artificial implant, the sutures are removed on the 10th, 15th day. It all depends on how soon the patient gets better.

Many patients ask themselves: upon arrival home, how to live on? After all, in the hospital they were under the vigilant supervision of doctors and staff, and the entire recovery process was under control.

Indeed, life with an endoprosthesis is somewhat different from the life that preceded endoprosthesis. It has already been said above that you need to constantly work on an artificial hip joint.

The patient should move as much as possible, but overwork and pain in the hip should not be allowed. A huge role in the recovery process is played by therapeutic exercises, but a set of exercises should be compiled by a doctor who takes the patient's medical history.

Returning home, the patient must work hard on the new joint, otherwise the recovery period can stretch for a long time.

If the patient does not want serious complications to arise after the operation and pain to recur after returning home, he must follow a number of recommendations.

1. Full bending of the artificial joint must not be allowed.
2. In the “sitting” position, it is impossible for the knees to be in the same plane with the hips, they should be located lower. Therefore, it is recommended to put a pillow on the chair.
3. Whatever position the patient is in, he should not cross his legs.
4. When getting up from a chair, the back should remain straight, you can not lean forward.
5. Crutches should be used until the doctor cancels them.
6. Walking in the first days after arthroplasty is possible only with the help of medical staff.
7. Shoes should be as comfortable as possible, so heels are contraindicated.
8. When visiting another doctor, he must be informed that the hip joint is artificial.

Hip replacement requires work not only on the joint itself, the patient must always and everywhere take care of his general state of health. If there is pain in the area of ​​the thigh in which the artificial implant was implanted, accompanied by an increase in body temperature, you should immediately contact your doctor.

Most likely, in the end, many of these recommendations can be abandoned. This will depend on how long it takes the patient to fully recover. Usually seven to eight months are enough for rehabilitation.

The patient should be informed that an artificial hip implant, like any mechanism, has its own lifespan. Therefore, over time, the endoprosthesis wears out. On average, its validity period lasts 10-15 years and depends on certain conditions and features.

If the endoprosthesis fails quickly, it is likely that it has been misused. Any active sports are contraindicated for a patient with an artificial hip prosthesis.

While doing physical therapy at home, the patient must be aware that ignoring the doctor's recommendations can provoke serious complications. Physical therapy exercises do not have to be difficult and cause pain. It is impossible to allow large loads on the artificial joint.

Life after hip arthroplasty

To normalize one's own life after hip arthroplasty, a task that will require the patient's full concentration of will and patience. Restoring the functional and social capabilities of a person after this operation will require a lot of time and effort.

• First days after surgery
• Later lifestyle
• Related videos

The entire rehabilitation period can be divided into two main stages:

1. Early postoperative, which begins at the end of the operation and is carried out in a medical facility.
2. Late postoperative, starting after a two-week course of wound healing, and continuing until the full restoration of all body functions.

First days after surgery

During the first two to three weeks after arthroplasty, the patient is in the hospital, under the vigilant supervision of medical personnel. In this period of life, the main tasks are the fastest possible healing of postoperative wounds and the elimination of possible inflammation. The work of all body systems is normalized, pressure ulcers are prevented. The patient in the early postoperative period is recommended to perform feasible exercises.

These include:

• sitting down on the bed, with the help of hands;
• turning the foot from side to side in a supine position;
• alternating tension of all muscles of the operated leg, with the exception of movement in the joints;
• enhanced physiotherapy exercises for a healthy leg and upper limbs.

To relieve swelling and pain after arthroplasty, specialized measures are carried out, such as magnetic and UHF therapy. My patients use a proven remedy, thanks to which you can get rid of pain in 2 weeks without much effort.

On average, a week after the operation, the physical therapy methodologist begins training procedures for adapting a person to life after hip replacement, for the first time. The essence of the classes is to teach the patient to move correctly, avoiding unnecessary stress on the sore leg and starting with the simplest exercises. Gradually, they learn to get up from the bed correctly and partially load the operated joint.

Two weeks after endoprosthetics, the patient is taught to move on a flat surface, using crutches or special walkers. This is the so-called tricycle walking, when the main distribution of body weight falls on crutches and a healthy limb.

Getting back to life after a hip replacement at home

The period of full recovery largely depends on how accurately and regularly the recommendations are followed after hip arthroplasty. At first, upon returning home, it is necessary to perform all the exercises prescribed by the physiotherapist for the diseased limb. By yourself or with the help of loved ones, to ensure comfortable movement around the apartment as much as possible.

The first full-fledged sex after hip arthroplasty is possible no earlier than one and a half months after returning home. During this time, complete regeneration and healing of damaged muscles and ligaments occurs. But at the first visit to the attending physician, it is advisable to consult about the most acceptable postures that will avoid unnecessary stress.

One of the most basic medical examinations is carried out after 6 months after hip arthroplasty. During this period of time, a person begins to move confidently, there is practically no pain. Upon examination, the doctor determines how well the artificial joint copes with its functions. Whether there are various pathological changes in the surrounding muscles and tissues. According to the results, the doctor prescribes a new set of exercises and makes adjustments to the early recommendations. At this stage, it is desirable to continue treatment in a specialized sanatorium.

On the hip replacement rehabilitation forum, you can find feedback from participants about specific rehabilitation centers or treatment dispensaries. A year after prosthetics, the doctor determines how much the new artificial joint has grown together with the bone, what changes have appeared in the surrounding tissues.

It must be constantly remembered that with the slightest deterioration in health, one should not postpone communication with the attending doctor. Swelling in the area of ​​the operation, fever of the skin or the whole body, redness - are signs of an immediate visit to the doctor.

Later lifestyle

So that the new joint does not cause various troubles in the future after arthroplasty, you should lead a certain lifestyle. The average service life of this prosthesis is 15-20 years. To prolong it, it is necessary to carefully monitor your own weight, avoid sudden movements and excessively load the operated leg.

Compliance with a diet rich in vitamins and minerals will strengthen bone tissue, as well as maintain muscle tone. Do not forget about regular visits to your doctor, who will monitor the condition and give all the necessary recommendations.

How to Recover After a Hip Replacement

Restoring the health of a patient who has undergone surgery on the joints is necessary after the very first hours after waking up from anesthesia. Rehabilitation after hip arthroplasty (HJ) is a set of exercises that are different for each period. It may also depend on the type of fixation of the prosthesis, the condition and age of the patient, and the presence of concomitant diseases. Rehabilitation should be carried out not only in the hospital, but also after discharge, in a medical specialized center or at home.

TBS rehabilitation - first of all it is physical exercises

Rehabilitation after hip arthroplasty

Rehabilitation after hip replacement is divided into early and late postoperative periods, which have different tasks and degrees of load on the diseased limb. The recovery of each patient is individual and is determined by many factors.

Recovery in the early postoperative period

Goals early period:

• Avoid postoperative complications
• Master exercises performed mainly lying down
• Learn to sit and stand
• Learn to walk on crutches

Dealing with possible complications

The main concerns for the early period after joint replacement:

• Care for correct position sore leg
• Reducing pain and swelling
• Wound dressing
• Maintaining a sparing diet

Requirements for leg position and movement

Reducing pain and swelling

No one can avoid pain after surgery. Anesthesia passes - and the inevitable pain attacks begin, also accompanied by edema. It is difficult for an already exhausted patient to endure this, and they come to the rescue:

• Pain therapy
• Drainage of accumulated fluid in the joint:
  • a drainage tube is inserted into the joint cavity, coming to the surface
  • the tube is removed as soon as the exudate stops accumulating in the cavity
• Ice pack on affected area
• If the pain is accompanied by an infectious process, then antibiotics should be used.

Wound dressings

• The first dressing is usually performed on the second day after surgery.
• The frequency of subsequent dressings is determined by the surgeon, with a frequency of at least one in two to three days
• The stitches are removed after 10-14 days:
  • removal of the threads can occur earlier if the wound is in a satisfactory condition
  • absorbable threads do not need to be removed

Intake of food and water

After the patient comes to, he may have thirst and appetite. This is a reaction to anesthesia. But you can drink a little and eat a little crackers only 6 hours after the operation. Regular meals are allowed the next day.

The first days you need to keep a diet that includes:

• Meat broth, lightly salted, with pureed meat
• Oatmeal, mashed potatoes
• lactic acid products
• Fruit jelly, unsweetened tea

Then the usual diet or the usual diet is prescribed, corresponding to the chronic diseases of the patient.

Prevention of thrombus formation

After surgery, blood clotting always increases - this is a natural reaction of the body, aimed at accelerating wound healing. Therefore, during this period there is always a threat of thrombosis, and if the patient also has a history of venous insufficiency, then the risk is doubly increased.

To prevent thrombosis, the following measures are used:

• Bandaging of the lower extremities with an elastic bandage
• Taking heparin, warfarin, and other anticoagulants
• Special exercises for limbs

Modes of loading on the operated side

• If a cement fixation method is used during joint replacement:
  • the initial load on the operated leg should already be in the early rehabilitation period, in the first postoperative days
  • full loads - later
• With cementless method of fixation:
  • 10 - 15% of full load - after 7 - 10 days
  • Half load - after 21 days
  • Full load - at the end of the two-month period
• Special clinical cases:
  • Stroke, diseases of internal organs, oncological diseases, extreme old age, etc. - in all these cases, exercise therapy should be started as soon as possible after surgery, and in full load mode.
• For acute pain:
  • the mode of limited load is applied at any stage of rehabilitation

The artificial joint has perfect mobility, but by itself it will not move: you need to “tie” it to the muscles. And this is possible only with the help of active rehabilitation, which strengthens the muscles.

Passive exercises on mechanical simulators after hip replacement are usually carried out to prevent muscle contractures, but not to strengthen the muscles. They cannot replace physical therapy, which must be performed with the application of one's own efforts and without which full recovery is impossible.

Early postoperative exercises

The goals of exercise therapy in the early postoperative period

After hip replacement at the very beginning of rehabilitation, the following goals are set:

• Prevent blood stasis, accelerate wound healing and reduce swelling
• Restore the supporting function of the sore leg and the full range of motion

Exercise therapy during the first two to three weeks is performed while lying in bed. But you need to get up on your feet literally on the second day

The complex of initial gymnastics is very simple, but there are certain requirements:

• Exercises are performed frequently throughout the day:
  • intensity - up to five to six times an hour for several minutes (it turns out on average per hour for therapeutic exercises takes 15 - 20 minutes)
• The nature and pace of the exercises - smooth and slow
• All exercises are combined with breathing, approximately according to the following scheme:
  • inhale with muscle tension
  • exhale while relaxing

The complex includes exercises for the calf, femoral and gluteal muscles of both limbs.

On the first postoperative day:

On the second day after the operation:

These exercises must be alternated with each other:

At one hour we do one thing, at the second we do something else, and so on.

How to sit properly

It is necessary to sit down carefully on the second day. How it's done?

You need to sit down, holding on to the handrail, in the direction of a healthy leg

• You need to lean on your elbows or hold on to the frame above the bed
• You need to sit down in the direction of a healthy leg, first lowering it to the floor, and then pulling up to it (you can also use an elastic bandage) the operated limb
• The roller between the legs must be mandatory
• Legs must first be bandaged with elastic bandages.
• When landing, you need to maintain a straight position of the body and do not turn the foot outward.

From the second day, mechanotherapy of the hip joint also begins.

Walking period after replacement of TBS

It can also be called “going through the throes”: too little time has passed since the operation, the wound still hurts, and the doctor, despite the pain, already orders to stand on crutches the very next day. And this is not a whim of a surgeon:

The sooner you start walking, the less likely you are to develop contractures and the more likely you are to regain full range of motion.

All the difficulties of walking on crutches are described in detail in our article Rehabilitation after knee arthroplasty, so we will focus only on the loads and walking on crutches on the stairs

• During the first postoperative week, you only need to touch the floor with your foot
• Then we move on to a 20% load on the sore leg: this is equivalent to transferring our own weight to it without the weight of the whole body, that is, we stand on the leg without relying on it

An increase in the load with bringing it to half should be carried out for each patient individually:
If the pain and swelling in the leg have not gone away, then the increase in the load is premature.

What are they talking about prolonged pain and puffiness

Pain that does not go away for a long time and swelling that does not subside may be signs of a postoperative complication, dislocation of the prosthesis, abuse of walking, or improperly performed therapeutic exercises.

In any case, the surgeon must understand the reasons.

Walking on crutches up stairs

The method of walking on crutches on the stairs is determined by the direction of movement - up or down

The walking technique is determined by the direction of movement - up or down:

• When climbing up the stairs, they begin to move from the non-operated limb:
  • We lean on crutches and transfer a healthy leg to the step
  • We push off with crutches and transfer the weight of the body to it
  • We pull up the operated leg, at the same time rearranging the crutches to the upper step, or we transfer the crutches after the sore leg
• When descending the stairs, all movements occur in the reverse order:
  • First, crutches are transferred to the lower step
  • Leaning on crutches, we put the sore leg down without emphasis
  • We transfer the healthy leg to the same step and lean on it

Walking on crutches up the stairs can be started after the exercises for a sore leg in a standing position have been mastered.

Exercise therapy on the tenth day after surgery

Standing exercises

Exercises in a horizontal position

• Repetition of all isometric exercises with pressing alternately the muscles of the lower leg, knee extensors and gluteal muscles to the floor:
  • Static tension is achieved by tensioning the abdominal muscle and pulling the toes of the feet towards you.
  • Isometric relaxation follows at the moment of relaxation
• Flexion and abduction of the sore leg to the side by the sliding method
• Lifting the sore leg at an angle of no more than 90 ° with keeping it in the air and slowly lowering
  

  Elevation of the operated leg at an angle

• Abduction of a sore leg to the side when positioned on its side:
  place a pillow between the legs
• 
  

  Flexion-extension of the legs in the supine position

All this exercise therapy complex should continue to be done at home.

Late rehabilitation of the hip joint

And now, two months have passed since the operation, but the hip joint is still quite constrained, and you step on the operated leg uncertainly. This means that a full recovery has not occurred and you need to continue rehabilitation:

• At home, perform the previous exercises plus gymnastics based on a sore leg
• Engage in simulators

Hip Exercise Bike

Exercise bike - effective method strengthening absolutely all the muscles connected to the work of the joint.

On the exercise bike, you need to set the light mode and the seat height corresponding to a small angle of flexion of the joints

However, you should not overdo it with it:

• Use the treadmill at low speed
• Adjust the seat height so that the hip joint does not flex more than 90°, and when the knee is extended, the foot just touches the bike pedals

Video: Rehabilitation of hip joint after joint replacement

Recovery after hip arthroplasty

Relatively recently, many patients suffering from arthrosis of the hip joint (coxarthrosis), or who received a fracture of the femoral neck, were doomed to complete disability due to the loss of the ability to move independently. Fortunately, the introduction of the latest technologies in medicine has allowed patients to avoid this fate and live their former full life. One of these technologies is total hip arthroplasty (TETS), when the entire hip joint (head, femoral neck, cartilaginous surface of the acetabulum) is replaced with a synthetic prosthesis. But in order for the synthetic joint to work as well as the “native” one, it is important not only to perform the operation at the classroom level. We need competent postoperative recovery or rehabilitation after arthroplasty. And it depends not only on the doctor, but also on the patient.

Problems

Check out the article:

Suprapatellar bursitis of the knee

By itself, TETS is a rather technically complex and traumatic operation. The skin and muscles are dissected, the bone and cartilage tissues of the worn joint are removed. Then the leg of the prosthesis is fixed in the femoral canal. Severe surgical trauma is accompanied by pain, release of biologically active substances from tissues into the blood. In turn, this leads to a change in the work of the heart, lungs, blood coagulation system. Preoperative preparation and anesthesia eliminate all these negative consequences, but only to some extent.

It goes without saying that people go for arthroplasty, to put it mildly, not from a good life. Such an operation requires strict indications. Such indications include the destruction of articular structures due to coxarthrosis or a fracture of the femoral neck. With coxarthrosis, as a result of long-term movement disorders, atrophic changes in the muscles of the lower limb, back develop, and the functioning of the pelvic organs is disrupted. The load on the spine increases, which leads to the development of lumbosacral osteochondrosis and sciatica.

It should not be forgotten that the vast majority of patients operated on for TETS are elderly and senile people. This means that they have impaired functions of the heart, respiration, endocrine system to varying degrees. In some patients, the disorders are decompensated and worsen after surgery. In addition, the operation itself and the postoperative bed rest lead to disruption of peristalsis (contractions) of the intestine up to the development of atonic intestinal obstruction. It should not be forgotten that in old age the ability to regenerate, heal tissues damaged during surgery is significantly reduced. Immunity is weakened, resulting in favorable conditions for the introduction of infection.

Thus, postoperative problems after hip arthroplasty are as follows:

• The patient is concerned about postoperative pain
• Existing muscle atrophy worsens
• Worsening cardiopulmonary insufficiency
• Disrupted bowel function
• There is a high risk of cerebral strokes due to jumps in blood pressure
• Blood clotting disorders can lead to thrombosis of the veins of the lower extremities and to an extremely serious condition - pulmonary embolism
• A postoperative wound can serve as an entry gate for infection.

Main directions of rehabilitation

Measures to restore motor functions and prevent postoperative complications are complex. Needless to say, the main emphasis is on exercise therapy (exercise therapy), which is designed to ensure optimal functioning of the newly found joint and the entire lower limb. In addition to exercise therapy, other therapeutic measures are carried out using drugs. various groups and physiotherapy procedures.

And the first such event is postoperative pain relief, during which they combine non-narcotic (Renalgan, Dexalgin) and narcotic (Morphine, Promedol) drugs. For the prevention of severe pulmonary heart failure, patients are prescribed cardiac agents (Mildronate, Riboxin, ATP). Such patients are shown inhalation (inhalation) of oxygen. Humidified oxygen is supplied through a special breathing apparatus.

Another important point is the prevention of thrombotic complications, which often develop in elderly patients after surgery. At the same time, parietal thrombi are formed in the veins of the lower extremities, which, breaking off, are brought into the pulmonary artery by the blood flow and clog it. Blockage of the main trunk of the pulmonary artery can cause instant death. To prevent this from happening, such patients are bandaged with an elastic bandage in the first few days after the operation and anti-clotting agents (Fraxiparine, Clexane) are injected subcutaneously. To eliminate postoperative atony of the intestine, injections of Prozerin, Ubretida are prescribed. Be sure to prescribe antibiotics (Ceftriaxone, Metrogyl).

Principles of exercise therapy

There is an erroneous opinion that exercise therapy after hip arthroplasty can be performed only in the late postoperative period, and strict rest is needed in the first days. This erroneous tactic can lead to contractures (persistent limitation of range of motion) and thrombotic complications. Therefore, some, the simplest loads, are carried out already on the first day after the operation, after coming out of anesthesia. In the implementation of exercise therapy, the principle of stages should be observed, when the exercises themselves are done in several phases.

Zero phase

Zero phase - on the first day after the operation, when the following types of exercises are performed:

• Adduction and abduction of the foot up and down several times every 10 minutes. - so-called. foot pump
• Rotations in ankle joint in both directions 5 times
• Short-term, 10 min each, tension of the anterior quadriceps femoris muscle
• Flexion of the knee while pulling the heel
• Buttock contractions followed by tension for 5 seconds
• Abduction of the operated leg to the side and return to the starting position
• Raise the straightened leg for a few seconds.

First phase

The first phase, 1-4 days after the operation - the so-called. strict care. At this time, it is allowed to sit on a hospital bed or on a chair, and then move around with the help of crutches or special walkers. Important: when landing, do not bend the limb in the hip joint more than 900, do not cross your legs. On the contrary, lying on the bed, try to take your leg to the side. To do this, you can put a pillow between your legs. The main types of exercises in this phase are performed in a standing position:

• Flexion of the leg at the knee and hip joints
• Straightening the leg at the hip joint and pulling it back
• Taking the leg to the side.

Second phase

The second phase of rehabilitation or deceptive possibilities - 5 days - 3 weeks after surgery. Many patients at this time feel a surge of energy, they are tired of stiffness and inactivity. But the joint is not yet strong, and muscle atrophy persists. In this phase, motor loads are shown - movement along a horizontal surface, but not more than 100-150m. or going up and down stairs. Climbing the stairs, you should lean on a cane or on a crutch. At the same time, first a healthy leg is placed on the higher step, then the operated one, and then a cane. When descending the stairs, everything is carried out in the reverse order.

Third phase

The third phase of rehabilitation, "the start of work" - after 1-2 months. after operation. At this time, the implanted joint "has taken root", and the muscles and ligaments have become so strong that you can gradually increase the load, and do it at home. Exercises during this period are similar to the previous ones, but are performed with weights. An elastic band can be used as a weight. One end of the tape is tied to the operated leg at the level of the ankles, and the other end is tied to a fixed object, such as a doorknob, after which flexion, extension and abduction are performed.

During this period, you can increase the duration of walking - half an hour 3-4 times a day. Even exercises on a stationary bike are shown. At the same time, one rule should not be forgotten - the appearance of pain serves as a signal to stop exercising. At the same time, it is not worth it for a long time, more than an hour, to sit in a fixed position. The right angle rule above must also be observed. In general, during each hour you should walk a little, for several minutes.

In the course of rehabilitation after endoprosthetics, exercise therapy is necessarily combined with physiotherapeutic procedures, including darsonval, phonophoresis, magnet, amplipulse. Thanks to these procedures, edema is finally eliminated, and muscle work is stimulated. The final stage rehabilitation of hip arthroplasty is a stay at mud resorts.

How to behave after hip arthroplasty: general recommendations

Rules to follow after hip arthroplasty:

1. In the first days after the operation, you can only sleep on your back, it is allowed to turn on your side after 3 days under the supervision of the medical staff and on your unoperated side. You can sleep on your unoperated side two weeks after arthroplasty.
2. In the early days, you need to avoid a large range of movements: you should not move sharply, turn your leg, etc.
3. When sitting on a chair or toilet, make sure that the operated joint does not bend more than 90 degrees, you can not bend down, squat, cross your legs and throw them one on top of the other. It is desirable to sleep on a high bed, chairs should also be high (like bar ones)
4. For the first six weeks after surgery, try to avoid taking a hot bath in favor of a warm shower. It is strictly forbidden during the first 1.5 - 3 months of the postoperative period to visit baths or saunas (to avoid thromboembolic complications).
5. You need to exercise regularly.
6. Sexual relations are allowed 1.5-2 months after the operation
7. It is better to exclude sports such as horse riding, running, jumping, weightlifting, preferring swimming and walking.

Nutrition after hip arthroplasty

After discharge and return home, the patient should eat a balanced diet. In this case, on the advice of a doctor, it is desirable:

• take certain vitamins;
• monitor weight;
• replenish the diet with iron-containing foods;
• limit your intake of coffee, alcohol and overconsumption vitamin K.

When do I need to see a doctor after joint replacement surgery?

Alarming symptoms indicating possible inflammation and complications of the rehabilitation period can be: high temperature (above 38 degrees), redness of the skin around the seam, discharge from the wound, chest pain, shortness of breath, increased pain in the joint, swelling. When these alarms you should contact your doctor immediately.

In some cases, a patient after hip arthroplasty is recommended to periodically take x-rays, take urine and blood tests so that doctors can follow the healing process.

The first follow-up examination is usually carried out 3 months after the operation. During it, it turns out how the joint "costs" and whether the leg can be fully loaded. The next follow-up examination is in 6 months. The purpose of this examination is to find out if you have osteoporosis or other bone disorders. The third control visit is carried out one year after the joint replacement. In the future, it is recommended to visit your doctor at least once every 2 years. Typically, the prosthesis lasts 15 years, sometimes 20-25, after which it is recommended to replace it.

Factors that accelerate joint wear and lead to complications:

• hypothermia, colds leading to an inflammatory process;
• excess weight: increases the load on the joint;
• the development of osteoporosis (loss of bone strength), the appearance of which contributes to sedentary image life, smoking, alcohol, the use of steroid hormones, malnutrition;
• carrying heavy weights, sudden movements and jumping on the operated leg.

Zero phase

The time period of this phase is the first day after arthroplasty. All movements are performed very carefully. During this time, you can do the following exercises:

1. "foot pump" - moving the foot up and down several times (this exercise should be done throughout the entire rehabilitation period);
2. short-term tension of the anterior thigh muscle;
3. contraction of the buttocks and holding them in this position for five seconds;
4. abduction to the side and return to the starting position of the operated leg;
5. bending the leg at the knee with heel support;
6. rotation of the foot of the operated leg clockwise and against it;
7. elevating the operated limb for a few seconds.

All exercises should be done slowly and very carefully. Each should be repeated about 10 times. Not all of these exercises can be obtained immediately. If in the process of performing any movement there are difficulties, then you can wait a little with it, and try again a little later.

Exercise therapy after endoprosthetics is one of the elements of rehabilitation

For prevention vascular disorders it is recommended to bandage both legs with elastic bandages. Do not forget about a healthy leg: it is recommended to raise and lower the leg, as well as take it to the side. It is forbidden to cross your legs. It is best to lie on your back. If you need to lie on your side, then there should be a roller between the thighs.

First phase ("strict care")

The duration of this phase is from one to four days after the operation. The patient can now gently sit on the bed. In this case, you can not cross your legs and strongly bend them at the hip joint, as well as lie on the operated side.

In a sitting position, the hip joint should not be allowed to be lower than the knee. It is recommended to sit on hard chairs, putting a pillow under the buttocks. It is not recommended to sit in soft chairs, as when standing up, the load on the hip joint will be too great. Lying on the bed, it is recommended to take the leg to the side. It is contraindicated to cross your legs.

The next day after arthroplasty, you can already start walking slowly, leaning on crutches. Almost all patients are advised to immediately try to step on the operated leg, the so-called loading according to the principle of pain tolerance. By the fourth day, you can already walk 100-150 meters several times a day.

New exercises are added to the exercises of the zero phase, which are performed in a standing position, but with support:

• flexion of the legs in the hip and knee joints;
• abduction of the straightened leg back.

Second phase ("deceptive possibilities")

This phase begins on the 5th and ends on the 21st day after arthroplasty. During this period, an increase in motor loads is expected. You can slowly go down and up the stairs, more long time is given to walking, observing the following rules:

1. Walking is recommended no more than 30 minutes at a time.
2. Climbing the stairs, first they put a healthy leg on the step, and only then the operated one.
3. Walking is allowed only with the help of crutches or special walkers.

This phase got the name “deceptive possibilities” because the pains almost disappear, and it seems to the patient that he can already do more than the doctor allows. Many of the patients neglect the rules, the observance of which prevents dislocation of the joint, stop putting the roller between the thighs. Violation of the rules can lead to increased pain and dislocation in the operated joint.

The main exercise therapy exercises that are added in this phase:

1. Lying on stomach:

• bending the leg at the knee so that the heel is directed towards the buttocks;
• raising the legs with the tension of the gluteal muscles.

1. Lying on your back:
2. alternately abducting the legs to the sides;
3. bending the legs at the knees, without lifting the feet from the floor.

Third phase ("getting started")

Exercises from the third phase of exercise therapy begin to be done when the muscles and ligaments are strong enough and the joint takes root. As a rule, this occurs 1-2 months after hip arthroplasty. All exercises can be done at home. The load is increased by weighting. For this, an elastic bandage is suitable. At this time, you no longer need to put a roller or pillow between your thighs.

The duration of walks on foot is gradually increasing up to 3-4 hours a day. Despite the fact that quite significant loads on the joint are already possible during this period, it is recommended to stop exercising if pain occurs.

At first, a rehabilitation specialist will help you to do special exercises.

Basic exercises:

• flexion of the leg in the hip joint with resistance;
• abduction of the operated leg to the side with resistance.

In this phase, you can start exercising on an exercise bike. The seat must be adjusted so that with a straightened knee, the feet barely reach the pedals. It is recommended to start classes by pedaling backwards. The first lessons should be short-term.

Late postoperative period

If more than three months have passed since the endoprosthesis replacement of the hip joint, and when walking in the operated leg, pain or discomfort occurs, you can unload it using a cane. Patients who have undergone hip replacement surgery can return to work in the workplace and drive a car after three months. However, if the work requires active movement, it is recommended to take a rest break every one to two hours. For those who cannot imagine their life without sports, skiing, swimming and cycling are recommended. It is important to remember that self-treatment after hip arthroplasty can not only not bring benefits, but also cause harm. Therefore, before you begin to perform certain exercises, you need to consult with your doctor.

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What is osteoarthritis

Osteoarthritis can affect any joint. Most often, DOA of the knee joints develops, then the spine. Osteoarthritis of the hip joints is the third most common. The process can be either one- or two-sided.

At the same time, the cartilage lining the surfaces of the adjacent bones is destroyed in the joint, the joint fluid becomes prone to inflammatory processes, and marginal bone growths appear. In the later stages, the joint space (space between the bones) disappears, and movement in the joint becomes impossible. The causes of the disease are:

• genetic predisposition;
• trauma;
• metabolic disorders (for example, deposits in the joints of uric acid, hydroxyapatites).

A characteristic symptom is pain in the projection area of ​​the joint, which intensifies during physical activity (walking). The pain syndrome can reach such intensity that the patient loses the ability to move independently. Osteoarthritis cannot be cured with conservative methods. With proper traditional treatment, it is only possible to maintain a state of remission. So the replacement of the hip joint is the only way to restore health and maintain working capacity. The duration of the operation is 1-3 hours. It depends on whether the prosthesis is carried out - full or partial. The patient is under general or spinal anesthesia. For a quick recovery and optimal results of treatment, it is necessary to start performing special exercises within a few hours after the end of the operation.

Stages of rehabilitation

Initial phase (1st day after surgery)

First of all, a set of exercises is prescribed to improve blood circulation in the legs and prevent the formation of blood clots. Such gymnastics is performed while sitting or lying down 3 times a day with both legs, regardless of whether the joint was replaced on one or both sides.

1. Static tension of the quadriceps femoris muscle.
2. Flexion of the leg at the knee.
3. Foot movement up and down.
4. Raising a straight leg 10 cm from the surface of the bed.
5. Leading the straight leg to the side.

The first phase (2–4 days after surgery)

The patient continues to perform the set of exercises he already has. New ones are added to them.

1. Raising the leg bent at the knee. Starting position - standing at the support.
2. Leading a straight leg to the side in a standing position.
3. Retraction of a straight leg back in a standing position.

The main goal of this rehabilitation period is to switch to complete self-care (get up, sit down, walk, go to the toilet on your own). At this time, there is a risk of dislocation of the prosthesis. In order to level it, it is necessary to sleep with a pillow between the knees, not to lie down on the operated side and not to keep the knees constantly bent, even if this reduces the pain.

Second phase (up to 21 days after arthroplasty)

The patient needs to continue to increase the load. Already at the end of the first week, you should learn to walk carefully up the stairs. When lifting, you first need to step with the operated leg, then with a healthy one, while descending - vice versa.

The risk of dislocation of the prosthesis remains, so it is necessary to follow all the recommendations of the previous stage.

Third phase (up to 2 months after surgery)

Phase of active training of the gluteal and femoral muscles. An elastic band acts as a kind of simulator, which allows you to perform all exercises with resistance (flexion in the hip joint while standing at the support, abduction of the leg in a standing position).

The patient should walk little and often, gradually increasing the walking time up to 2 hours a day in several stages.

In the department of physical therapy (in the hospital and the clinic), the patient is assigned exercises on a stationary bike, which perfectly develop muscles, as well as stepping onto the platform.

Fourth phase (up to 4 months after prosthetics)

This time is fraught with hidden danger for patients. Having successfully passed the previous stages of rehabilitation, having learned to walk without a cane, without feeling pain and mobility restrictions, people stop doing exercises. This is a big mistake! Insufficiently strong muscles, especially in the elderly, quickly detrain, which increases the risk of injury (falling due to loss of balance, for example).

Exercises to strengthen the muscles of the legs should be performed regularly for a long time, preferably for life. You can't train through pain. However, do not confuse joint pain with muscle pain (due to the accumulation of lactic acid) and, under this pretext, refuse to exercise. You should perform semi-squats (strictly with a straight back), stepping, abducting a straight leg with resistance or a slight weight, walking along the track or exercising on an exercise bike.

You should also follow a balanced diet. The diet should contain a large amount of proteins (with the exception of patients with gout), carbohydrates (preferably long ones, i.e. cereals, whole grain pastries), fats (necessarily with a sufficient amount of omega-3 unsaturated fatty acids from seafood). Proper nutrition will help not to gain excess weight to avoid stress on the joint.

The list of medicines will be issued by the attending physician. It usually includes vitamin complexes and supplements containing glucosamine and chondroitin at therapeutic doses.

Hip arthroplasty with proper rehabilitation allows the patient to return to daily life in the shortest possible time.

Hip arthroplasty: recovery and rehabilitation

The hip joint is the largest joint in the human body. By connecting the torso and legs, it receives a large load, so diseases and lesions of this joint cause unbearable pain, which requires immediate medical attention.

Among the diseases of the hip joint: coxarthrosis, infectious arthritis, pathology of blood supply to bones and others. Endoprosthetics of the hip joint is the replacement of a destroyed joint element with an implant. The implant can be made of materials such as metal or ceramic and contain stainless steel, cobalt, chromium or titanium. The surgeon selects the appropriate material and the size of this material, based on individual indicators. The prosthesis serves (in older people) for life, but younger patients may need a second operation on the hip joint.

Operation on the hip joint

These operations have been carried out for thirty years and every year it is carried out with the help of more and more advanced technologies, which significantly improve the results. As a result, patients experience unbearable pain that accompanies any injury to the hip joint. To ensure that there are no complications during and after the operation, tell your doctor comprehensive information about your state of health. If you smoke, the doctor should definitely be aware of this, since nicotine affects both the speed of rehabilitation and the patient's well-being during surgery. To avoid unforeseen circumstances, you should also not place the dentist before the operation - blood from the mouth can enter the bloodstream, infecting the joint. Hip arthroplasty requires a thorough examination.

During surgery, sometimes suddenly become the right blood patient - it is better to hand over yours in advance, because it is not known how the body will react to someone else's blood, which is usually prepared by doctors for every firefighter.

Total hip arthroplasty (both the pelvic and femoral elements of the joint are replaced) is, first of all, a longer-term operation of the implant, which eliminates the need for revision hip arthroplasty. In addition, in this case, the implant performs its function better, although there are also disadvantages: this operation is more dangerous and blood loss in this case is greater.

Complications of hip arthroplasty occur and depend on the characteristics of the body and lifestyle of the patient, as well as on the quality of the operation and the knowledge of the surgeon who performs it. Statistics show that the most frequent complications occurred when using implants of poor quality - these are the first implants of the last century. With the progress in modern medicine, the number of complications has decreased significantly. After hip arthroplasty, the patient can apply for a pension. The disability group after hip arthroplasty and the size of the pension, respectively, are set according to the patient's ability to move around, go to the store, and so on.

Recovery after hip surgery

The duration of recovery after surgery depends on the patient - each period of rehabilitation is individual. Recovery after hip arthroplasty does not include any specific technique, but some rules should still be followed.

1. When sitting on a chair, place a pillow on the seat so that your knees are lower than your hips.
2. Avoid too sudden movements, turns with legs, crossings, and so on - all these manipulations will negatively affect the patient's well-being and the speed of his rehabilitation.
3. Lying on your side (just not on the leg that was operated on), put a small pillow between your legs to avoid displacement.

If symptoms such as fever appear, pain increases, swelling or other similar phenomena are observed, then you should immediately consult a doctor.

It is worth remembering that it is important when exactly the operation was performed - immediately after the joint damage or after a long time. Of course, in the first case, muscle work can be fully restored, which cannot be said about the second case.

Rehabilitation after hip arthroplasty begins already in the hospital and continues at home for about a month. To increase the chances of fully rehabilitating, the patient must strictly follow the recommendations of doctors.

It is more difficult to rehabilitate older patients, so medical rehabilitation begins even before surgery. Of course, hip arthroplasty, the rehabilitation of which takes time, is a complicated procedure, but do not despair - you will succeed.

Exercises for rehabilitation after hip arthroplasty

Exercise is an important part of restoring the work of muscles that atrophy if they are not done. Exercises after hip arthroplasty are quite painful, as the pain does not subside immediately after the operation. However, you should not spare yourself too much, because then it will be much more difficult to recover.

It is important that the patient knows what he is facing. Hip arthroplasty, the video of which can be viewed on the Internet, will give you an idea about this.

Lifetime general recommendations after hip arthroplasty

As you probably already understood, recovery after hip arthroplasty is a long and responsible process. How seriously you take it will determine the end result - your return to normal life without pain in the legs.​

In addition, in the early recovery period after hip arthroplasty, it is important to ensure that the leg is not in one position. for a long time. Periodically put a roller under the knee joint and hold it for about 20 minutes. And keep in mind that the leg should be in a slightly retracted state all the time, and the fingers should be pointed up.

Reasons for prosthetics

Weakening of the joint, accompanied by pain - is detected over time, and sometimes surgical intervention is required to eliminate this complication;

1. find a shirt with many pockets or a small shoulder bag where you can put the most necessary items so that you don’t have to get up often for them;
2. For the next three days, the patient learns to move independently with the help of crutches or a walker. You can’t shirk, even in case of dizziness. You need to wait until the weakness passes, and train further.
3. One of the most common causes of described pain is the instability of the endoprosthesis and inflammation of the surrounding tissues. Clinically, it is quite difficult to recognize. Perhaps, not a conventional x-ray, but a computer tomogram is needed. Yes, and only those doctors who put the prosthesis should be consulted about this. An ordinary traumatologist or orthopedist leading an outpatient appointment cannot always help in this regard.
4. Walking on crutches is necessary as much as recommended by the attending physician.
5. In most cases, already on the third day of rehabilitation, the patient can walk, while using crutches and relying on the help of a specialist. After how many days can the stitches be removed? It depends on how quickly the patient recovers. On average, stitches are removed 10-15 days after hip replacement surgery.​

The use of one or another prosthesis depends on the number of elements to be replaced. The friction node is the implementation of interaction in an artificial joint. How long can a hip replacement last? This will depend on the type and quality of the material used in the friction unit.​

What is a joint prosthesis made of?

At first, the patient is forced to walk on crutches. How long will it take to recover?​

A hip arthroplasty is the replacement of a damaged joint element. For this, special implants are used. Endoprostheses may be required for a variety of reasons (injuries and diseases of the hip joint). There are certain guidelines to follow after hip arthroplasty.​

You will be allowed to get out of bed after 5-7 days. For the first time, a doctor will help you, he will also instruct you about the use of crutches. As soon as you learn how to stand steadily on crutches, you will be advised to take the first step. It is painful, but necessary.

Change in leg length - eliminated by physical activity;

Features of a modern hip endoprosthesis

You need to remove carpets and electrical wires from places where you have to walk on crutches;

• Stage 2 - 10-12 days the patient is in the hospital. This time he should devote to the development of the joint. For this, walking up the stairs and physiotherapy exercises are mastered. The purpose of the measures is to restore the muscle corset around the joint.​
• ​Indirectly on possible inflammation the tissues surrounding the joint also indicate the duration of healing of the postoperative wound. Although several months have passed since then, the inflammation may reassert itself. In any case, the presence of an inflammatory process can be verified using a routine blood test. Another reason is also possible, which is by no means related to the endoprosthesis. Joint pain can radiate from the lower back, and be due to lumbar osteochondrosis. But here, too, research is needed - X-ray or computed tomography of the spine.
• In the early days, you should only walk under the supervision of a specialist.
• How to live after discharge from the hospital? Many people ask themselves: how to live after returning home? In the hospital, the patient is constantly under the supervision of the medical staff, who controls the entire rehabilitation process. Life with a hip replacement is somewhat different from normal life. As already mentioned, in order to restore mobility, it is necessary to constantly work on the hip joint.

The main indications for surgical treatment are the results of clinical and radiological studies and the symptoms that accompany the disease. The symptoms that the patient complains about are one of the most significant factors indicating the need for surgery.​

). Each individual element has its own dimensions. The surgeon must choose and set the size that is ideal for the patient.​

The postoperative period and full recovery depend on the age of the patient, his general condition and many other factors. In order to avoid complications after hip arthroplasty, it is necessary to follow all the recommendations of the attending physician.​

Worn joint replacement surgery

1. The duration of rehabilitation after hip arthroplasty is not the same for everyone. It varies depending on age, health status and other factors. The purpose of this stage is to strengthen the muscles of the lower extremities and master the minimum skills of walking with a new joint. To do this, every day several times you will have to perform simple exercises that the doctor will show. And here one problem may arise: since you will already feel good, at some point it may seem to you that the goal has been achieved, motor activity has been restored, and now you can use your leg as usual. However, you should not immediately run a marathon after making such a decision. The load should be increased gradually. The first two months - no more than 30 minutes of walking per day. Crush it 3-4 times, rest the rest of the time, not forgetting to put a roller to fix the leg in the allotted state.​
2. Disturbance of joint mobility - caused by the accumulation of salts in the tissues surrounding the joint, due to which they become denser;
3. If the house is two-story, and the bedroom is on the second floor, and the kitchen and living room are on the first floor, then at first you need to convert the living room into a bedroom so that you do not have to use the stairs.

Stage 3 - over the next 3-4 weeks, you need to switch from crutches to a cane, and then start moving without support. Required hiking, starting from 10 minutes and longer, exercises with an elastic band on a low step, exercises on an exercise bike. Pain at this stage is already insignificant, which gives some patients reason to consider the 3rd period of rehabilitation optional. This is not so: the normal operation of the prosthesis is possible only with the correct, coordinated work of all thigh muscles. Having shown weakness of character at this time, you can permanently deprive yourself of the opportunity to walk.

Diseases of the musculoskeletal system have one common feature: the rehabilitation period is much longer than the treatment period and requires much more patience and effort. Replacement of failed joints with prostheses is no exception.​

• Shoes should be low-soled, walking in it should be as comfortable as possible.
• The patient should walk as much as possible, while avoiding severe overwork. Physical therapy plays an important role in the rehabilitation process, all exercises must be approved by the attending physician. After discharge from the hospital, the patient can visit special centers where qualified exercise therapy instructors will work with him.​

In some cases, despite the fact that coxarthrosis is at one of the last stages of development (this is evidenced by x-ray examination), the patient is practically not bothered by anything. There may not be a need for surgical intervention.

When does a patient need a hip arthroplasty?

Types of fixation of hip endoprostheses have the following differences:

​Exercise after hip reconstruction surgery should be performed strictly under the supervision of a qualified specialist. Living with a new routine will speed up the recovery process. The patient will be able to walk much faster without the help of crutches.

How are hip arthroplasty performed?

The most common reasons why endoprostheses may be needed are:

To avoid overworking, dress while sitting. Socks and shoes will have to be put on with the help of someone, as the prosthesis can react strongly to excessive bending. The same goes for picking up items from the floor. And forget about physical work for a while.​

Destruction of the prosthesis - operable intervention is also required.

Rehabilitation process after surgery

Additionally, it is necessary to install special handrails in the bathroom and raise the toilet seat so that the flexion of the hip joint is minimal. Special raised seats are now on sale.​

Stage 4 begins at 8-9 weeks and includes balance exercises. Maintaining balance is the most difficult thing for the musculoskeletal system, and training will allow you to fully recover.​

Lifetime recommendations to follow after arthroplasty

Pain after hip arthroplasty and in other similar cases is inevitable.

When visiting a doctor, it is important to immediately inform him that the hip joint is artificial.

How long can it take to stay in the hospital? It depends on the general condition of the patient. On average, the primary recovery of the body takes 10-15 days.​

Hip replacement surgery is performed by two teams (operating and anesthesia). The operating team operates under the guidance of a highly qualified operating surgeon.​

​Cement fixation.​

Pain after arthroplasty, as a rule, has a pronounced character. In no case should you take any measures on your own, otherwise serious complications can be provoked.

Advanced and severe stages of rheumatoid arthritis.

Tips to follow after leaving the hospital

Since you will be periodically observed by a doctor after the operation, you will promptly learn about any changes. So, if the doctor decides that a long-term rehabilitation period has come for you, this will mean that the load on the joint will become more serious and intense. The task of the third stage is the adaptation of the new joint to normal motor activity.​

1. To avoid such complications, you must carefully follow the doctor's recommendations, and remember that an artificial joint is still not as good as a natural one. You can learn about the rehabilitation of the hip joint after endoportesis from the video.​
2. ​The doctor will tell you about dressings and special procedures, such as removing drainage or sutures, and for any question you should consult a doctor, so you need to have his contacts. Particular attention should be paid to the relief of postoperative pain, for which tablets and injections are used. It is also possible to install an intravenous or epidural catheter, with which the medicine is delivered on demand, you just need to press a special button.​
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4. By itself, the prosthesis, if installed correctly, does not cause any pain. But during the operation, the muscles of the thigh and fascia are cut and then sewn together. Fusion of tissues takes a lot of time - about 3-4 weeks, and during this period the movement will be accompanied by pain.
5. After the operation, it is necessary not only to work on the artificial hip joint (walk, perform special exercises, etc.), but also to monitor the general condition of the body. In the event that pain often begins to occur in the thigh area (which is accompanied by increased body temperature), you should consult your doctor.
6. Returning home, the patient should understand that if he does not walk and work hard on the hip joint, then the recovery process can be significantly delayed.
7. The place where the surgeon makes the incision to replace the joint
8. ​Cementless fixation.​
9. To date, orthopedics has made significant progress in its development. A feature of modern endoprosthesis is a complex technical design. In the prosthesis, which is characterized by cementless fixation, there are the following elements:

Injuries to the femoral neck (most often fractures).

Additional Information

You will switch from crutches to a cane. It will be made for you according to your height. You will have to walk with a cane for at least 6 months, and then it will need to be kept at hand in case of fatigue.

Hip arthroplasty is an operation that solves the problem of reduced mobility and pain in the legs. However, even before the operation, doctors will warn you that in order to achieve a positive result, that is, a complete return to normal life, a long-term rehabilitation will be required after the operation, the success of which will depend only on you.​

Performing exercises under the supervision of a specialist will help speed up the recovery process, however, at first they should wear minimal loads, and movements in which the joint flexes are contraindicated. In the future, you should also not engage in serious sports activity, as this is fraught with various complications.

How to get rid of pain after hip arthroplasty?

Sometimes hip arthroplasty is the only way out in case of serious damage to the hip joint. And modern medical technologies make it possible to relatively quickly and painlessly replace a natural joint with an artificial prosthesis. At the same time, after a month and a half, motor activity returns to the patient, and he can move normally without crutches. However, full recovery occurs only within a year, during which certain actions are contraindicated, especially those that must be observed in the postoperative period, i.e. the first few months. What is life like after arthroplasty?​

Until the muscles have grown together, the prosthesis is in an overly loose position. Therefore, at the first stage of rehabilitation, movement is limited so as not to provoke a dislocation of the joint. This should be monitored by both the patient and the attending physician. A dislocation, if it occurs, is accompanied by pain, sharp and sharp, blocking any movement.

Why did pain occur after hip arthroplasty | Joints without pain - it's possible

In order to avoid serious complications after the operation, after being discharged home, the patient must follow a number of recommendations:

On average, a hip replacement surgery takes 1.5-2 hours, while the patient is under the influence of spinal anesthesia or anesthesia. In order to exclude infectious complications, intravenous administration of an antibiotic is necessary.

Cause of the pain symptom

Hybrid type of prosthesis fixation.

head;

The need for exercise

Development of hip dysplasia.

You will be offered a different set of exercises. It will be possible to do semi-squats with support and transfer the body weight to the operated leg.​

Stages of rehabilitation

After hip arthroplasty, everyone experiences severe pain, the most comfortable position for a person in this case is inactivity. But it is important to get out of this comfort zone and force yourself to get used to the new joint.

• In 98% of cases, the installed prosthesis lasts more than 10 years, but you need to understand that the more active the sport (volleyball, tennis, basketball, skiing, etc.), the higher the risk of prosthesis wear.

In order for the rehabilitation to go well, you need to prepare for it in advance, and it is important to remember that at first you will need the help of relatives. Your home needs to be turned into a kind of recovery center, in which everything is at hand. To do this, you need to follow these simple rules:

• Preparation for the rehabilitation period begins even before the operation. Therefore, pain after hip arthroplasty is not a surprise for the patient. Pain is not a reason for inaction.​
• As you understand, a hip joint endoprosthesis, like any mechanism, has its own service life. Gradually, the prosthesis wears out, it is possible to walk with it up to 15 years. How quickly the prosthesis fails depends mainly on the conditions of its use. Active Views sports for a person with an artificial hip prosthesis are contraindicated.
• It is very important not to allow full flexion of the hip joint.

After endoprosthetics, the patient remains in the intensive care unit for some time, under the close supervision of doctors. Within 7 days, the patient continues to be given antibiotics and drugs that can prevent blood clotting. In order to fix a certain distance between the legs, a pillow is installed. In this case, the legs should be in the allotted position. The temperature after hip replacement surgery is often unstable, so doctors carefully monitor this.​

Life after hip arthroplasty: rehabilitation, exercise, pain

​Reviews about each individual prosthesis are quite different, so it is recommended to collect as much information as possible before replacing the hip joint.​

Change of interior

leg;

• The presence of aseptic necrosis of the head, which is called avascular necrosis.
• You will be allowed to swim, ski and bike. These actions develop the new joint well without causing undue stress.​
• Rehabilitation after hip arthroplasty is divided into several periods. We will write below 3 main periods.​
• It is best to prioritize calm views sports - golf, swimming, cycling, etc. As for the first months after the operation, the doctor develops a special program for this time, consisting of gentle physical exercises. Already a week after the operation, the patient's load will increase - he will be able to walk along the corridor, around the ward, and even perform simple exercises for the feet and legs, but only under the supervision of a specialist.​
• ​find a small bench and pillows to keep your sore leg calm while watching TV;​
• In order for the prosthesis to function normally in the future, it is necessary to achieve its correct fixation. Without movement, the ligaments and muscles will not be able to grow together properly and fix the joint.​

When doing physical therapy at home, the patient must understand that non-compliance with the rules can lead to complications. Exercises should be fairly easy to perform. You can not allow excessive stress on the body.

Postoperative pain relief

When the patient is sitting, the knees should not be at the same level with the hips. In order for the knees to be lower, it is recommended to sit on a pillow.​

Physical exercise

How long will it take to recover from a hip arthroplasty? This is impossible to predict. In order to speed up the rehabilitation process, you must carefully follow all the doctor's recommendations.​

A hip replacement can be:

cup;

Possible complications after arthroplasty

Severe stages of coxarthrosis.

• You will be closed sick leave with the condition that you will not do hard physical work.
• Occurs immediately after surgery. Its goal is to prevent complications. As soon as you wake up from anesthesia, you need to feel your legs. Periodically move your fingers and try to bend them at the knees. Purposefully develop them, even if through pain. However, at the same time, listen to your body - do not torture it too intensely. After all, complications even after successful hip arthroplasty are not at all uncommon.
• You need to understand that non-compliance with medical recommendations can lead to complications such as:
• Give away pets for a while so that they do not get in the way;
• The purpose of the rehabilitation period is to fully restore the functions of the hip joint and the muscles and ligaments surrounding it. Patience and willpower of the patient is the only guarantee that the prosthesis can fully replace the joint.​

If during the exercise the patient felt pain and discomfort in the thigh area, it is necessary to abandon the exercise.

Rehabilitation after hip arthroplasty: put your new joint to work

The patient should not cross his legs, no matter what position he is in.

Stages of rehabilitation after hip arthroplasty

The patient is encouraged to move the next day. Without getting up from the pastel, the patient can sit down and even do therapeutic exercises. Exercises after hip arthroplasty, which the patient performs in the first month after surgery, are as simple as possible.​

total;

Early period

insert.

The need for an endoprosthesis may arise due to post-traumatic consequences (for example, arthrosis).

In addition to physical exercises, do breathing exercises - inhale and exhale deeply. This is necessary to restore the functioning of the respiratory and cardiovascular systems, which inevitably suffer during surgery.​

Displacement of prostheses - occurs when the legs are crossed or the hip joint is bent more than 80 degrees;

Late period: rehabilitation after discharge from the hospital (up to three months after surgery)

All the most important items should be placed at the level of the hands so that you do not have to reach or bend over them;

Stage 1 begins immediately after recovery from anesthesia. Flexion and extension of the foot, rotation of the foot, tension and relaxation of the buttocks - these simple exercises allow you to restore normal blood flow in the pelvic area. The patient spends the first day in a supine position, but the exercise must be started immediately.

Long-term period: rehabilitation three months after surgery

Dexamethasone is an anti-inflammatory drug, a synthetic analogue of the steroid hormones of the adrenal cortex. These hormones, and dexamethasone among them, have a versatile effect on the human body. Among other things, they dilate the bronchi and inhibit the course of inflammatory reactions. And the fact that after taking dexamethasone the condition improves, indicates the presence of inflammation. It remains only to find out where it is localized and what causes it.​

• Getting up from a chair, you need to make sure that your back is even.
• In order to fully restore mobility, it is necessary to constantly work on the hip joint, while observing all the recommendations of the attending physician. In addition to exercise therapy, the patient is prescribed breathing exercises.
• unipolar.
• The difference between the cement-retained endoprosthesis is a one-piece acetabular element (cup and

The life of the patient after arthroplasty, as a rule, changes: a number of recommendations appear that the patient must strictly follow. After endoprosthetics, there are some restrictions, the patient needs special therapeutic exercises.​

However, you will still not be able to lean forward. This can be done last - at the moment when the doctor announces to you that the joint is well developed and you can use it intensively.

You will spend a couple of days after the operation in the department intensive care, then you will be transferred to a separate room, and there an exercise therapy instructor will work with you. He will show a set of exercises that should be performed: lifting the leg, tightening the thigh muscles, bending the leg at the knee, moving it to the side. Your task is to do them at least twice a day until fatigue appears.​

Hip arthroplasty is an operation to replace the affected joint with an endoprosthesis. As with any other surgery, complications can occur. This is due to the individual characteristics of the organism, the state of health and the complexity of the operation.

Pain after arthroplasty is inevitable. This is due to the nature of the operation.

Risk factors

• The advanced age of the patient.
• Associated systemic diseases.
• Past operations or infectious diseases of the hip joint in history.
• The presence of acute trauma of the proximal femur.

Possible Complications

Rejection by the body of a foreign body (implant)

This consequence occurs extremely rarely, because Usually, before the operation, after choosing the prosthesis, tests are carried out for 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 is treated for a long time with antibiotics. Infection may occur in wound surface or in the depth of 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, then the prosthesis will need to be replaced 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

Change in leg length

If the prosthesis has not been fitted correctly, the muscles near the joint may weaken. They need to be strengthened, and exercise is the best way to do this.

Deep vein thrombosis

After a decrease in motor activity in the postoperative period, blood stasis may occur, and as a result, the occurrence of blood clots. And then it all depends on the size of the blood clot and where it will be carried by the blood stream. Depending on this, the following consequences may occur: pulmonary thromboembolism, gangrene of the lower extremities, heart attack, etc. To prevent this complication, it is necessary to start active activities at the appointed time, and anticoagulants are prescribed on the second day after the operation.

Also, over time, the following complications may occur:

• Weakening of the joints and disruption of their functioning.
• Destruction of the prosthesis (partial or complete).
• Dislocation of the endoprosthesis head.
• Lameness.

These complications after hip arthroplasty occur less frequently and over time. To eliminate them, you need surgery (replacement of the endoprosthesis).

Pain after hip replacement

The only complication that will accompany arthroplasty 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 for about 3-4 weeks. When performing movements, pain will occur. And since the movements are mandatory so that the muscles grow together faster and correctly, the pain will be felt for almost the entire period of rehabilitation.

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.

Dislocation of the hip joint is the separation of the acetabulum and the articular end of the femur. Pathology occurs due to trauma (both in children and adults), due to disorders in the development of the joint, and can also be congenital.

Kinds

Such dislocations are classified according to the nature of their origin:

• Traumatic
  It develops due to a direct effect on the joint (impact, pressure). As a rule, such a dislocation is accompanied by ruptures inside the articular bag. The condition can be complicated by tissue infringement, bone fractures.
• Pathological
  Most often, pathological dislocation of the hip joint is the result of joint inflammation.
• Congenital
  Associated with developmental pathologies that occur during fetal development. Congenital dislocation is diagnosed in newborns, in children under 1 year old.

Also, injuries are divided into types:

• posterior dislocation
  Such a dislocation is characterized by damage to the head of the femoral bone, which moves back and up relative to the joint. This type of injury often occurs in car accidents.
• anterior dislocation
  In case of injury, the joint capsule ruptures and the head of the bone moves forward with a downward displacement. There is a similar injury when falling on a limb turned outward.
• central dislocation
  Highly serious damage, which is characterized by protrusion of the head of the bone and retraction of the large nerve. With such a dislocation, the acetabulum collapses.

In this article, we talk about all the possible causes of pain in the hip joint.
What can pain in the hips during pregnancy mean?

Symptoms

Common symptoms and photos of hip dislocation:

• sharp, severe pain;
• forced unnatural position of the leg;
• shortening of the leg (from the side of the violation);
• joint deformity;
• significant movement restrictions.

With an anterior dislocation, there is a slight flexion of the limb in the joint and its abduction to the side, the knee is turned outward.

With a posterior dislocation, the knee is directed inward, the limb is bent at the hip joint, brought to the body. Often there is a shortening of the leg on the side of the injury.

Severe pain, articular deformity, shortening of the leg are characteristic of central dislocation. The knee is slightly turned both outward and inward.

Diagnostics, photo

In order to confirm the presence of this injury, it is necessary to consult a traumatologist. He examines the patient, palpates the damaged area, examines the symptoms.

Each patient, without exception, needs to take an x-ray in the anterior and lateral projections. This method allows you to find out the exact location of the head of the bone and establish a probable tissue disorder.

CT and MRI are performed when radiography does not provide the necessary information to confirm the diagnosis.

Help

Should I call an ambulance?

The ambulance team that arrives will take the person to the nearest hospital, where, using general anesthesia, they will correct the dislocation.

Self-management of the joint is an action that, as a rule, does not bring results. The fact is that the most powerful muscles are located around the joint, which, in case of injury, become very tense. Muscles can be weakened only with the help of anesthesia. In addition, incorrect actions increase the risk serious complications especially if a hip fracture has occurred, injury large vessels, nerves.

What can be done?

1. The first step is to give the patient some pain medication. The most effective is the introduction of analgesics by injection into the muscle. You can use the following drugs for pain: Analgin; Tramal
2. Further, it is very important to perform immobilization, that is, to fix the injured limb. For these purposes, you can use sticks, iron bars (it is important to first wrap the objects with a bandage). Another fixation option is a method in which the damaged limb is attached to a healthy one.
3. During immobilization, it is necessary to fix the leg exactly in the position that it took after the dislocation. It is strictly forbidden to bend, unbend, turn the limb!
4. After fixing the leg, it is necessary to act on it with cold. For this, an ice pack, a cloth dampened with cold water, can be used.

Treatment in adults

Reposition according to Dzhanilidze

The reduction of dislocation of the joint in adults by these methods is carried out as follows:

1. after introducing the patient into deep anesthesia, he is laid face down on the table so that the affected limb hangs freely;
2. two bags filled with sand are placed under the human pelvis;
3. the doctor's assistant puts pressure on the sacrum of the patient, fixing it;
4. the surgeon bends the patient's leg at the knee and places his knee in his popliteal fossa;
5. stubbornly pressing the knee, the specialist twists the injured leg outward.

Reduction according to Kocher

When the first method did not give positive results, they resort to the Kocher reduction method, which is carried out exclusively in adults in the following order:

1. the patient is anesthetized and placed face up on the table;
2. the patient's pelvis is securely fixed by a doctor's assistant;
3. the surgeon bends the leg at the knee and hip, makes several sharp circular movements with the patient's sore leg, due to which natural position joint is restored.

The described methods of treatment are unacceptable for children!

After reduction

The field of the manipulation, the patient is imposed with a splint in such a way as to fix the hip joint, knee and ankle.
It happens that after reduction, it is necessary to impose skeletal traction. This is done as follows:

1. After the patient has been placed under anesthesia, tibia a surgical needle is carried out, on which a bracket with a load is attached.
2. After reduction, strict bed rest is shown, lasting at least a month. After this period, the patient is allowed to walk, using crutches for support, which must be used for the next 2-3 months.

Treatment of a Complicated Hip Dislocation

Complications of hip dislocations include:
the impossibility of reduction by the Kocher or Dzhanilidze method. This happens when the joint capsule or tissues that have fallen into the gap between the acetabulum and the head of the bone interfere with the reduction;
ligament rupture.

In such cases, surgical treatment is performed, during which the surgeon makes an incision that opens access to the damaged joint. The doctor eliminates all disorders (tissues that have fallen into the joint, stitches the ligaments) and sets the head of the bone.

Operation

Two types of operations are used to treat an old dislocation:

• Open reduction, which can only be carried out when articular surfaces saved. Arthrodesis - fixation of the joint, the changes of which are irreversible, and the functions are completely lost. After such a surgical intervention, the patient can rely on the damaged limb.
• Endoprosthetics

A method of treatment in which the damaged joint is replaced with an artificial one that fully corresponds to the structure of a healthy joint.
The selection of an endoprosthesis is made individually and depends on the following parameters:

• general state the patient's health;
• age;
• Lifestyle.

The goal of arthroplasty is to reduce pain in the joint and restore its functional function. The service life of the endoprosthesis is up to 20 years, after which it is replaced.

Treatment of newborns, children

For the treatment of children with hip dislocation (congenital or traumatic), both conservative and surgical treatment is used. Most often, surgical intervention in newborns is not performed, however, with complex congenital dislocation, the baby is shown just such a treatment.

As a treatment for children, a splint is used to fix the legs of a newborn in a position in which they are bent at the knee and hip joints at an angle of 90 ° or abducted at the joints. This helps the correct formation of the joints in the future. The reduction is carried out smoothly, sedately, avoiding the possibility of injury. It is unacceptable to make significant efforts during the procedure for newborns.

Experts advise to use a wide swaddling of a newborn, to conduct therapeutic exercises.

Consequences of dislocation of the joint

The consequences of this pathology can be very dangerous. Among them greatest risks for health they include:

• violation of large vessels, which can cause necrosis of the femoral head, tissue destruction.
• contusion of the sciatic nerve, in which there are sensory disorders, movement disorders, severe pain;
• compression of the femoral vessels, as a result of which there is a violation of blood circulation in the legs;
• violation of the obturator nerve, resulting in muscle disorders.

Due to the likelihood of complications from hip dislocation, especially in children and newborns, it is necessary to consult a doctor.

Find out how you can quickly help yourself if your back is pinched in the lower back.
What is vertebrogenic lumbodynia and about various ways her treatment, read here
Here you can find out why back pain occurs after epidural anesthesia.

Rehabilitation

After a dislocation, the patient must undergo a long course of comprehensive rehabilitation, which includes:
Massage.
In the first sessions, massage is a gentle effect in the form of rubbing and stroking, which are aimed at restoring blood flow at the site of injury. Subsequent sessions become more intense, kneading techniques are used;
exercise therapy.
At the initial stage, exercise therapy is aimed at maintaining normal blood circulation in the muscles, in order to avoid their atrophy. Then include exercises aimed at maintaining articular mobility (flexion / extension, adduction / abduction). At the last stage of physiotherapy exercises, exercises are performed to restore the functions of the joint.

Physiotherapy

Physiotherapy treatments include:

• magnetotherapy;
• exposure to diadynamic currents;
• exposure to heat, etc.

The treatment program is developed individually.
Spa treatment

During the recovery period after a dislocation of the hip joint, patients are recommended to undergo treatment in sanatorium-resort conditions:

• Sanatorium "Rainbow", Republic of Bashkortostan, Ufa, Avrora st., 14/1.
• Sanatorium "Oren-Krym", Russia, Republic of Crimea, Evpatoria, Frunze st., 17.
• Sanatorium "Lunevo", Russia, Kostroma region, Kostroma district, p / o Sukhonogovo, village Lunevo

Dislocation after arthroplasty

There are many reasons for the dislocation of the endoprosthesis head. The most common are:

• advanced age of the patient;
• muscle weakness;
• inflammation of the joints;
• neurology in history;
• unsuitable size of parts of the endoprosthesis (or the entire endoprosthesis);
• unhealthy lifestyle (smoking, alcoholism, drug abuse), etc.

Most often, dislocation after arthroplasty occurs when the tissues have not yet fully strengthened and recovered. Such dislocations are reduced by a closed method, using anesthesia with muscle relaxants, after which conservative treatment is carried out.

Repetitive dislocations of the endoprosthesis are set openly. It happens that some parts of the endoprosthesis require replacement.

Pain after dislocation

If, after reduction, the patient continues to suffer pain, you can use painkillers such as Ibuprofen, Analgin, Tempalgin, etc. Such remedies help eliminate the pain symptom, but, nevertheless, for their correct use, consultation of the attending physician is necessary.

There are folk methods of getting rid of pain after a dislocation.

So, ordinary fat, which is applied with a thin plate on the joint area, will help reduce soreness. After the fat is depleted, it must be replaced with a new one.

Another remedy for pain is mustard ointment. To prepare it, you need to mix 50 g of salt, 25 g of mustard and a little kerosene. The mixture should acquire a creamy consistency, you need to use it at night, rubbing it into a sore spot.

Prevention

Main preventive measures are considered:

• keeping healthy lifestyle life;
• sports (to develop and maintain joint flexibility);
• timely contacting a doctor if any symptoms occur;
• strict adherence to the doctor's prescriptions if the newborn was diagnosed with a congenital dislocation.

Which doctor to contact and the prognosis of treatment

This pathology is dealt with by a traumatologist and orthopedist.

With a simple injury, the prognosis is favorable. The treatment and rehabilitation carried out most often guarantees that the patient will return to normal life. Timely treatment more complex dislocations also lead to complete recovery, however, in this case, there is a risk of developing degenerative joint pathologies in the future.

What are osteophytes and spines of the knee joint and how to remove them?

Osteophytes are pathological growths on the surface of bone tissue. Such processes are unusual for a healthy skeleton. They can be of different shapes and sizes.

Basically, these are small minor irregularities or tubercles. In advanced cases, osteophytes take the form of spikes that cause acute pain.

Causes of osteophytes

Osteophytes arise from cartilage tissue which is gradually growing. At the first stage of the disease, it is soft and elastic, but gradually it begins to ossify. The shoots take on a sensitive shape. They can even be felt through the skin and muscles.

There are many reasons that can provoke the appearance of spikes in the knee joint:

1. Predisposition at the genetic level. If one of the relatives suffered from this disease, then the risk of its development increases significantly.
2. Arthrosis of the knee joint. In this disease, inflammation of the joint occurs, which begins with cartilage and passes to the bone.
3. Injuries that may result in detachment bone structure, and wander around the knee joint, irritating the surrounding tissues. Injuries accompanied by infections can also cause growths and calluses.
4. Prolonged stress on the knees can provoke shrinkage and friction of the cartilage, which can cause microtrauma. Damaged cartilage begins to actively divide.
5. Malignant tumors stimulate the appearance of osteophytes, usually quite large.
6. Operations on the knee joints can cause the growth of spikes.
7. Chronic diseases of neuropathic origin.
8. Prolonged specific inflammation caused by tuberculosis or syphilis.
9. Pathological changes in the skeleton, in which tuberosities appear on the bones.
10. Hormonal disorders.

Characteristic features

There are symptoms that indicate the development of osteophytes in the knee:

• when moving in the knee, a crunch occurs;
• after sleep it is difficult to bend or straighten the knee;
• when weather conditions change, the knee begins to “twist”;
• as it grows, the osteophyte irritates pain receptors, resulting in acute pain that prevents full movement.

Diagnostic goals

Diagnosis allows you to identify the presence of osteophytes, as well as the stage at which the disease is located.

In the diagnosis, three main research methods are used:

1. X-ray of the joint. This method makes it possible to determine the shape and size of the identified osteophytes, the state of the joint space. However, using this study, it is impossible to obtain information about changes in the periarticular tissues.
2. CT scan. With its help, you can scan the diseased joint in layers, determine the condition of the surface and ligaments of the joint, as well as periarticular tissues. The study makes it possible to detect oncological changes or an inflammatory process in tissues.
3. Magnetic resonance imaging of the knee. The most effective method for diagnosing pathological changes in the joint. Osteophytes are single and multiple, and have a different shape.

Complex of therapeutic measures

The goal of removing spines and osteophytes in the knee joint is to eliminate the symptoms that cause discomfort during movement, as well as to restore the joint to work.

Traditional Methods

Treatment of osteophytes of the knee joint is carried out according to the following scheme:

Surgical removal of spines as a last resort

Surgical intervention is used in the case when drug treatment has not brought the desired effect. There are two types of surgical treatment:

• arthroscopic - a small incision is made through which video equipment is inserted, with its help, osteophytes are removed;
• arthroplasty - removal of a damaged joint, instead of which a metal implant is inserted.

ethnoscience

Treatment of folk remedies for osteophytes of the knee joint can be carried out in combination with drug therapy. Before use, consult with your doctor.

The following recipes are used:

Rehabilitation after surgery

When performing arthroscopy, rehabilitation begins immediately after the operation is completed. A pressure bandage is applied to the knee to prevent hemorrhage into the joint cavity or swelling, the leg is placed on an elevation, the place is applied cold.

On the first day, exercises are prescribed, which are performed under the supervision of a physiotherapist. On day 3, you are allowed to get up, you can fully load the knee only after a week.

Rehabilitation after arthroplasty includes measures for the development of the knee, the return of a normal gait, as well as power loads.

Possible Complications

Complications may occur after surgery.

After arthroscopy, there may be inflammatory response. A few days after the operation, pain and swelling persist, which are eliminated with the help of drug therapy.

In rare cases, ligaments, cartilage, or synovium. Also, there may be fluid accumulation in the joint bag, deep vein phlebitis, or an infection inside the joint.

Complications after arthroplasty are extremely rare. Basically, they can develop against the background of chronic diseases of the patient. The most common complication is thrombosis. In rare cases, excessive scarring may occur.

How to avoid thorns?

To avoid such a problem, follow these recommendations:

1. Control your weight. Extra pounds create additional stress on the knees. Nutrition must be balanced.
2. Follow the sleep schedule, while sleeping on a flat, hard surface.
3. Watch your posture while working at the computer. It is necessary to take regular breaks during which to perform exercises.
4. Go in for sports. Even a little physical activity will help to avoid problems with the joints.

At the first symptoms of the development of osteophytes in the knee joints, it is necessary to consult a specialist. After diagnosing, he will prescribe you an effective treatment. In no case do not self-medicate! Be healthy!

Table of Contents [Show]

Possible consequences of hip arthroplasty

Hip arthroplasty is an operation to replace the affected joint with an endoprosthesis. As with any other surgery, complications can occur. This is due to the individual characteristics of the organism, the state of health and the complexity of the operation.

Pain after arthroplasty is inevitable. This is due to the nature of the operation.

Risk factors

• The advanced age of the patient.
• Associated systemic diseases.
• Past operations or infectious diseases of the hip joint in history.
• The presence of acute trauma of the proximal femur.

Possible Complications

Rejection by the body of a foreign body (implant)

This consequence occurs extremely rarely, because Usually, before the operation, after choosing the prosthesis, tests are carried out for 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 is treated for a long time with antibiotics. Infection can occur on the wound surface or in the depth of 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, then the prosthesis will need to be replaced 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

Change in leg length

If the prosthesis has not been fitted correctly, the muscles near the joint may weaken. They need to be strengthened, and exercise is the best way to do this.

Deep vein thrombosis

After a decrease in motor activity in the postoperative period, blood stasis may occur, and as a result, the occurrence of blood clots. And then it all depends on the size of the blood clot and where it will be carried by the blood stream. Depending on this, the following consequences may occur: pulmonary thromboembolism, gangrene of the lower extremities, heart attack, etc. To prevent this complication, it is necessary to start active activities at the appointed time, and anticoagulants are prescribed on the second day after the operation.

Also, over time, the following complications may occur:

• Weakening of the joints and disruption of their functioning.
• Destruction of the prosthesis (partial or complete).
• Dislocation of the endoprosthesis head.
• Lameness.

These complications after hip arthroplasty occur less frequently and over time. To eliminate them, you need surgery (replacement of the endoprosthesis).

Pain after hip replacement

The only complication that will accompany arthroplasty 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 for about 3-4 weeks. When performing movements, pain will occur. And since the movements are mandatory so that the muscles grow together faster and correctly, the pain will be felt for almost the entire period of rehabilitation.

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.

Dislocation of the hip joint is the separation of the acetabulum and the articular end of the femur. Pathology occurs due to trauma (both in children and adults), due to disorders in the development of the joint, and can also be congenital.

Kinds

Such dislocations are classified according to the nature of their origin:

• Traumatic
  It develops due to a direct effect on the joint (impact, pressure). As a rule, such a dislocation is accompanied by ruptures inside the articular bag. The condition can be complicated by tissue infringement, bone fractures.
• Pathological
  Most often, pathological dislocation of the hip joint is the result of joint inflammation.
• Congenital
  Associated with developmental pathologies that occur during fetal development. Congenital dislocation is diagnosed in newborns, in children under 1 year old.

Also, injuries are divided into types:

• posterior dislocation
  Such a dislocation is characterized by damage to the head of the femoral bone, which moves back and up relative to the joint. This type of injury often occurs in car accidents.
• anterior dislocation
  In case of injury, the joint capsule ruptures and the head of the bone moves forward with a downward displacement. There is a similar injury when falling on a limb turned outward.
• central dislocation
  A very serious injury, which is characterized by protrusion of the head of the bone and retraction of a large nerve. With such a dislocation, the acetabulum collapses.

In this article, we talk about all the possible causes of pain in the hip joint.
What can pain in the hips during pregnancy mean?

Symptoms

Common symptoms and photos of hip dislocation:

• sharp, severe pain;
• forced unnatural position of the leg;
• shortening of the leg (from the side of the violation);
• joint deformity;
• significant movement restrictions.

With an anterior dislocation, there is a slight flexion of the limb in the joint and its abduction to the side, the knee is turned outward.

With a posterior dislocation, the knee is directed inward, the limb is bent at the hip joint, brought to the body. Often there is a shortening of the leg on the side of the injury.

Severe pain, articular deformity, shortening of the leg are characteristic of central dislocation. The knee is slightly turned both outward and inward.

Diagnostics, photo

In order to confirm the presence of this injury, it is necessary to consult a traumatologist. He examines the patient, palpates the damaged area, examines the symptoms.

Each patient, without exception, needs to take an x-ray in the anterior and lateral projections. This method allows you to find out the exact location of the head of the bone and establish a probable tissue disorder.

CT and MRI are performed when radiography does not provide the necessary information to confirm the diagnosis.

Help

Should I call an ambulance?

The ambulance team that arrives will take the person to the nearest hospital, where, using general anesthesia, they will correct the dislocation.

Self-management of the joint is an action that, as a rule, does not bring results. The fact is that the most powerful muscles are located around the joint, which, in case of injury, become very tense. Muscles can be weakened only with the help of anesthesia. In addition, incorrect actions increase the risk of serious complications, especially if there is a fracture of the femoral neck, damage to large vessels, nerves.

What can be done?

1. The first step is to give the patient some pain medication. The most effective is the introduction of analgesics by injection into the muscle. You can use the following drugs for pain: Analgin; Tramal
2. Further, it is very important to perform immobilization, that is, to fix the injured limb. For these purposes, you can use sticks, iron bars (it is important to first wrap the objects with a bandage). Another fixation option is a method in which the damaged limb is attached to a healthy one.
3. During immobilization, it is necessary to fix the leg exactly in the position that it took after the dislocation. It is strictly forbidden to bend, unbend, turn the limb!
4. After fixing the leg, it is necessary to act on it with cold. For this, an ice pack, a cloth dampened with cold water, can be used.

Treatment in adults

Reposition according to Dzhanilidze

The reduction of dislocation of the joint in adults by these methods is carried out as follows:

1. after introducing the patient into deep anesthesia, he is laid face down on the table so that the affected limb hangs freely;
2. two bags filled with sand are placed under the human pelvis;
3. the doctor's assistant puts pressure on the sacrum of the patient, fixing it;
4. the surgeon bends the patient's leg at the knee and places his knee in his popliteal fossa;
5. stubbornly pressing the knee, the specialist twists the injured leg outward.

Reduction according to Kocher

When the first method did not give positive results, they resort to the Kocher reduction method, which is carried out exclusively in adults in the following order:

1. the patient is anesthetized and placed face up on the table;
2. the patient's pelvis is securely fixed by a doctor's assistant;
3. the surgeon bends the leg at the knee and hip, makes several sharp circular movements with the patient's sore leg, due to which the natural position of the joint is restored.

The described methods of treatment are unacceptable for children!

After reduction

The field of the manipulation, the patient is imposed with a splint in such a way as to fix the hip joint, knee and ankle.
It happens that after reduction, it is necessary to impose skeletal traction. This is done as follows:

1. After introducing the patient into anesthesia, a surgical needle is passed through the tibia, on which a bracket with a load is attached.
2. After reduction, strict bed rest is shown, lasting at least a month. After this period, the patient is allowed to walk, using crutches for support, which must be used for the next 2-3 months.

Treatment of a Complicated Hip Dislocation

Complications of hip dislocations include:
the impossibility of reduction by the Kocher or Dzhanilidze method. This happens when the joint capsule or tissues that have fallen into the gap between the acetabulum and the head of the bone interfere with the reduction;
ligament rupture.

In such cases, surgical treatment is performed, during which the surgeon makes an incision that opens access to the damaged joint. The doctor eliminates all disorders (tissues that have fallen into the joint, stitches the ligaments) and sets the head of the bone.

Operation

Two types of operations are used to treat an old dislocation:

• Open reduction, which can be carried out only when the articular surfaces are preserved. Arthrodesis is the fixation of a joint, the changes of which are irreversible, and the functions are completely lost. After such a surgical intervention, the patient can rely on the damaged limb.
• Endoprosthetics

A method of treatment in which the damaged joint is replaced with an artificial one that fully corresponds to the structure of a healthy joint.
The selection of an endoprosthesis is made individually and depends on the following parameters:

• the general state of health of the patient;
• age;
• Lifestyle.

The goal of arthroplasty is to reduce pain in the joint and restore its functional function. The service life of the endoprosthesis is up to 20 years, after which it is replaced.

Treatment of newborns, children

For the treatment of children with hip dislocation (congenital or traumatic), both conservative and surgical treatment is used. Most often, surgical intervention in newborns is not performed, however, with complex congenital dislocation, the baby is shown just such a treatment.

As a treatment for children, a splint is used to fix the legs of a newborn in a position in which they are bent at the knee and hip joints at an angle of 90 ° or abducted at the joints. This helps the correct formation of the joints in the future. The reduction is carried out smoothly, sedately, avoiding the possibility of injury. It is unacceptable to make significant efforts during the procedure for newborns.

Experts advise to use a wide swaddling of a newborn, to conduct therapeutic exercises.

Consequences of dislocation of the joint

The consequences of this pathology can be very dangerous. Among them, the greatest health risks are:

• violation of large vessels, which can cause necrosis of the femoral head, tissue destruction.
• contusion of the sciatic nerve, in which there are sensory disorders, movement disorders, severe pain;
• compression of the femoral vessels, as a result of which there is a violation of blood circulation in the legs;
• violation of the obturator nerve, resulting in muscle disorders.

Due to the likelihood of complications from hip dislocation, especially in children and newborns, it is necessary to consult a doctor.

Find out how you can quickly help yourself if your back is pinched in the lower back.
What is vertebrogenic lumbodynia and about the various methods of its treatment, read here
Here you can find out why back pain occurs after epidural anesthesia.

Rehabilitation

After a dislocation, the patient must undergo a long course of comprehensive rehabilitation, which includes:
Massage.
In the first sessions, massage is a gentle effect in the form of rubbing and stroking, which are aimed at restoring blood flow at the site of injury. Subsequent sessions become more intense, kneading techniques are used;
exercise therapy.
At the initial stage, exercise therapy is aimed at maintaining normal blood circulation in the muscles, in order to avoid their atrophy. Then include exercises aimed at maintaining articular mobility (flexion / extension, adduction / abduction). At the last stage of physiotherapy exercises, exercises are performed to restore the functions of the joint.

Physiotherapy

Physiotherapy treatments include:

• magnetotherapy;
• exposure to diadynamic currents;
• exposure to heat, etc.

The treatment program is developed individually.
Spa treatment

During the recovery period after a dislocation of the hip joint, patients are recommended to undergo treatment in sanatorium-resort conditions:

• Sanatorium "Rainbow", Republic of Bashkortostan, Ufa, Avrora st., 14/1.
• Sanatorium "Oren-Krym", Russia, Republic of Crimea, Evpatoria, Frunze st., 17.
• Sanatorium "Lunevo", Russia, Kostroma region, Kostroma district, p / o Sukhonogovo, village Lunevo

Dislocation after arthroplasty

There are many reasons for the dislocation of the endoprosthesis head. The most common are:

• advanced age of the patient;
• muscle weakness;
• inflammation of the joints;
• neurology in history;
• unsuitable size of parts of the endoprosthesis (or the entire endoprosthesis);
• unhealthy lifestyle (smoking, alcoholism, drug abuse), etc.

Most often, dislocation after arthroplasty occurs when the tissues have not yet fully strengthened and recovered. Such dislocations are reduced by a closed method, using anesthesia with muscle relaxants, after which conservative treatment is carried out.

Repetitive dislocations of the endoprosthesis are set openly. It happens that some parts of the endoprosthesis require replacement.

Pain after dislocation

If, after reduction, the patient continues to suffer pain, you can use painkillers such as Ibuprofen, Analgin, Tempalgin, etc. Such remedies help eliminate the pain symptom, but, nevertheless, for their correct use, consultation of the attending physician is necessary.

There are folk methods of getting rid of pain after a dislocation.

So, ordinary fat, which is applied with a thin plate on the joint area, will help reduce soreness. After the fat is depleted, it must be replaced with a new one.

Another remedy for pain is mustard ointment. To prepare it, you need to mix 50 g of salt, 25 g of mustard and a little kerosene. The mixture should acquire a creamy consistency, you need to use it at night, rubbing it into a sore spot.

Prevention

The main preventive measures are:

• maintaining a healthy lifestyle;
• sports (to develop and maintain joint flexibility);
• timely contacting a doctor if any symptoms occur;
• strict adherence to the doctor's prescriptions if the newborn was diagnosed with a congenital dislocation.

Which doctor to contact and the prognosis of treatment

This pathology is dealt with by a traumatologist and orthopedist.

With a simple injury, the prognosis is favorable. The treatment and rehabilitation carried out most often guarantees that the patient will return to normal life. Timely treatment of more complex dislocations also leads to complete recovery, but in this case there is a risk of developing degenerative joint pathologies in the future.

What are osteophytes and spines of the knee joint and how to remove them?

Osteophytes are pathological growths on the surface of bone tissue. Such processes are unusual for a healthy skeleton. They can be of different shapes and sizes.

Basically, these are small minor irregularities or tubercles. In advanced cases, osteophytes take the form of spikes that cause acute pain.

Causes of osteophytes

Osteophytes arise from cartilage tissue, which gradually grows. At the first stage of the disease, it is soft and elastic, but gradually it begins to ossify. The shoots take on a sensitive shape. They can even be felt through the skin and muscles.

There are many reasons that can provoke the appearance of spikes in the knee joint:

1. Predisposition at the genetic level. If one of the relatives suffered from this disease, then the risk of its development increases significantly.
2. Arthrosis of the knee joint. In this disease, inflammation of the joint occurs, which begins with cartilage and passes to the bone.
3. Injuries, as a result of which the bone structure can detach and wander around the knee joint, irritating the surrounding tissues. Injuries accompanied by infections can also cause growths and calluses.
4. Prolonged stress on the knees can provoke shrinkage and friction of the cartilage, which can cause microtrauma. Damaged cartilage begins to actively divide.
5. Malignant tumors stimulate the appearance of osteophytes, usually quite large.
6. Operations on the knee joints can cause the growth of spikes.
7. Chronic diseases of neuropathic origin.
8. Prolonged specific inflammation caused by tuberculosis or syphilis.
9. Pathological changes in the skeleton, in which tuberosities appear on the bones.
10. Hormonal disorders.

Characteristic features

There are symptoms that indicate the development of osteophytes in the knee:

• when moving in the knee, a crunch occurs;
• after sleep it is difficult to bend or straighten the knee;
• when weather conditions change, the knee begins to “twist”;
• as it grows, the osteophyte irritates pain receptors, resulting in acute pain that prevents full movement.

Diagnostic goals

Diagnosis allows you to identify the presence of osteophytes, as well as the stage at which the disease is located.

In the diagnosis, three main research methods are used:

1. X-ray of the joint. This method makes it possible to determine the shape and size of the identified osteophytes, the state of the joint space. However, using this study, it is impossible to obtain information about changes in the periarticular tissues.
2. CT scan. With its help, you can scan the diseased joint in layers, determine the condition of the surface and ligaments of the joint, as well as periarticular tissues. The study makes it possible to detect oncological changes or an inflammatory process in tissues.
3. Magnetic resonance imaging of the knee. The most effective method for diagnosing pathological changes in the joint. Osteophytes are single and multiple, and have a different shape.

Complex of therapeutic measures

The goal of removing spines and osteophytes in the knee joint is to eliminate the symptoms that cause discomfort during movement, as well as to restore the joint to work.

Traditional Methods

Treatment of osteophytes of the knee joint is carried out according to the following scheme:

1. First of all, the joint is anesthetized. To do this, use: Diclofenac, Ibuprofen, Analgin, Aspirin or Butadion. They also have an anti-inflammatory effect, however, they irritate the walls of the stomach (taken only after meals). People suffering from diseases gastrointestinal tract, appoint Ketanov, Rofecoxib, Celebrex.
2. In the absence of an inflammatory process, Andecalin, Angitrofin, Depokallikrein and other drugs are used.
3. If the disease is accompanied by inflammation, Gordicos or Kontrykal is prescribed, while the risk-benefit ratio is carefully evaluated.
4. Drugs that stimulate tissue nutrition in general: a nicotinic acid, ATP, L-lysine, Actovergin, B vitamins, Solcoseryl.
5. Medicines that restore the remaining cartilage of the joint, which include chondroitin sulfate and glucosamine. Treatment is effective if there is no inflammation in the cartilage.
6. Preparations based on avocado and soy. They are quite expensive, but very effective.
7. Insertion into the joint hyaluronic acid, which is analogous to joint fluid.
8. The use of warming compresses based on medical bile, Bishofit or Dimexide.

Surgical removal of spines as a last resort

Surgical intervention is used in the case when drug treatment has not brought the desired effect. There are two types of surgical treatment:

• arthroscopic - a small incision is made through which video equipment is inserted, with its help, osteophytes are removed;
• arthroplasty - removal of a damaged joint, instead of which a metal implant is inserted.

ethnoscience

Treatment of osteophytes of the knee joint with folk remedies can be carried out in combination with drug therapy. Before use, consult with your doctor.

The following recipes are used:

1. Compress using blue and red clay. Take the powder and dilute it with water to a consistency homemade sour cream. Lay out the mixture in two layers on a clean cotton cloth. Wash the joint, and put a gin on it, wrap it with a bandage, and warm it with a woolen scarf on top. Leave for two hours, then rinse with warm water.
2. Mix a tablespoon of honey with 60 ml of apple cider vinegar. Apply the mixture to the affected joint. Put a cabbage leaf on top, wrap with polyethylene, and insulate with a scarf. Hold the compress until the sheet dries. The course of treatment is a month.
3. After taking a hot bath, apply a piece of kombucha to the steamed knee, which should be kept for about two hours.
4. Finely chop 1.5 kg of Jerusalem artichoke leaves, and pour 8 liters of boiling water over them. When the water becomes warm, dip your foot into it so that the tincture completely covers the joint. The procedure is performed for 30 minutes, daily for 10 days.
5. A leaf of plantain, coltsfoot or burdock can be applied to a sore knee.
6. Grind the walnut kernels into a pulp. Put the gruel on a clean knee and leave until some oil is absorbed into the knee.
7. Combine honey and mummy, melt the solution in a water bath. Rub the resulting mixture overnight.

Rehabilitation after surgery

When performing arthroscopy, rehabilitation begins immediately after the operation is completed. A pressure bandage is applied to the knee to prevent hemorrhage into the joint cavity or swelling, the leg is placed on an elevation, the place is applied cold.

On the first day, exercises are prescribed, which are performed under the supervision of a physiotherapist. On day 3, you are allowed to get up, you can fully load the knee only after a week.

Rehabilitation after arthroplasty includes measures for the development of the knee, the return of a normal gait, as well as power loads.

Possible Complications

Complications may occur after surgery.

After arthroscopy, an inflammatory reaction may occur. A few days after the operation, pain and swelling persist, which are eliminated with the help of drug therapy.

In rare cases, ligaments, cartilage, or synovium may be damaged during surgery. Also, there may be fluid accumulation in the joint bag, deep vein phlebitis, or an infection inside the joint.

Complications after arthroplasty are extremely rare. Basically, they can develop against the background of chronic diseases of the patient. The most common complication is thrombosis. In rare cases, excessive scarring may occur.

How to avoid thorns?

To avoid such a problem, follow these recommendations:

1. Control your weight. Extra pounds create additional stress on the knees. Nutrition must be balanced.
2. Follow the sleep schedule, while sleeping on a flat, hard surface.
3. Watch your posture while working at the computer. It is necessary to take regular breaks during which to perform exercises.
4. Go in for sports. Even a little physical activity will help to avoid problems with the joints.

At the first symptoms of the development of osteophytes in the knee joints, it is necessary to consult a specialist. After diagnosing, he will prescribe you an effective treatment. In no case do not self-medicate! Be healthy!

Studies show that complications after hip arthroplasty develop in 1% of young people and 2.5% of older patients. Despite the meager likelihood of developing negative consequences, they can affect anyone, and especially those who did not strictly follow the rehabilitation program.

Image of the position of the endoprosthesis in the human body.

Complications after hip arthroplasty are caused by improper postoperative care and physical activity regimen after discharge from the hospital. The second reason is the mistakes of the surgeon. And third, this is an inferior preoperative examination, as a result of which latent infections (tonsils, cystitis, etc.) were not cured. The success of treatment is affected by the qualifications of the medical staff, where the patient received high-tech medical care - surgical and rehabilitation treatment.

The pain is different, there is a "good" - after moderate physical exertion. And there is a “bad” one, talking about problems that need to be urgently diagnosed.

Complication statistics in percent

The operation to install a hip prosthesis is the only method that "puts" the patient on his feet, relieves debilitating pain and limited ability to work, and allows you to return to healthy physical activity. Unpleasant pathological situations associated with implantation occur infrequently, about which the patient should be informed. According to ongoing randomized controlled trials, the following data were obtained:

• dislocation of the head of the prosthesis develops in approximately 1.9% of cases;
• septic pathogenesis - in 1.37%;
• thromboembolism– in 0.3%;
• periprosthetic fracture occurs in 0.2% of cases.

They develop not through the fault of the surgeon, but the patient himself, who did not continue rehabilitation or did not adhere to a special physical regime after the end of recovery. The deterioration of the condition occurs already at home, when there is no that careful control by the doctors that was in the clinic.

If you have had an operation, enough time has passed, but the leg cannot repeat the amplitude of movement of a healthy limb, then this is the result of a lack of rehabilitation.

Not a single orthopedic specialist, even with rich and impeccable work experience, can 100% predict how a particular organism will behave after such complex manipulations on the musculoskeletal system, and give the patient a complete guarantee that everything will go smoothly and without excesses.

Differentiation of pain: normal or not

Pain after hip arthroplasty will be observed in the early period, because the body has experienced a serious orthopedic operation. Painful syndrome during the first 2-3 weeks is a natural response of the body to a recent surgical injury, which is not considered a deviation.

Until the surgical injury heals, the muscle structures do not return to normal, until the bones, together with the endoprosthesis, become a single kinematic link, the person will experience discomfort for some time. Therefore, a good pain reliever is prescribed, which helps and makes it easier to endure early painful symptoms, and it is better to concentrate on treatment and rehabilitation classes.

Well healing suture after surgery. It is even, pale and has no discharge.

Pain sensations should be differentiated and examined: which of them is the norm, and which is a real threat. This can be done by the operating surgeon. The task of the patient is to notify the orthopedist in case of any uncomfortable signs.

Main Risk Factors

Surgical intervention does not exclude complications, and serious ones. Especially if mistakes were made in the intra- and / or post-operative period. Even small errors during surgery or during rehabilitation increase the likelihood of unsatisfactory hip arthroplasty. There are also risk factors that increase the body's predisposition to postoperative consequences and often become their cause:

• advanced age of a person;
• severe concomitant disease, for example, diabetes mellitus, arthritis of rheumatoid etiology, psoriasis, lupus erythematosus;
• any previous surgical intervention on the "native" joint, aimed at the treatment of dysplasia, femoral fractures, coxarthrosis deformities (osteosynthesis, osteotomy, etc.);
• re-endoprosthetics, that is, repeated replacement of the hip joint;
• local inflammation and purulent foci in the patient's history.

It should be noted that after the replacement of the hip joints, older people, and especially those over 60, are more susceptible to complications. In addition to the underlying disease, older patients have comorbidities that can complicate the course of rehabilitation, for example, reduce resistance to infection. There is a reduced potential for reparative and restorative functions, weakness of the musculo-ligamentous system, osteoporotic signs, and lymphovenous insufficiency of the lower extremities.

It is more difficult for older people to recover, but this is also done successfully.

The concept and methods of treating the consequences

Symptoms of complications after hip arthroplasty for better perception will be presented in the table below. A quick visit to the doctor at the first suspicious signs will help to avoid the progression of adverse events, and in some situations, save the implant without revision surgery. The more neglected the clinical picture becomes, the more difficult it will be for therapeutic correction.

Dislocations and subluxations of the endoprosthesis

Negative kurtosis occurs in the first year after prosthetics. This is the most common pathological condition in which there is a displacement of the femoral component in relation to the acetabular element, resulting in separation of the head and cup of the endoprosthesis. The provocative factor is excessive loads, errors in the selection of the model and installation of the implant (defects in the setting angle), the use of posterior surgical access, injuries.

Dislocation of the femoral component on x-ray.

The risk group includes people with hip fractures, dysplasia, neuromuscular pathologies, obesity, joint hypermobility, Ehlers syndrome, patients over 60 years of age. Also particularly vulnerable to dislocation are individuals who have undergone surgery on a natural hip joint in the past. The dislocation needs non-surgical reduction or an open method. With timely treatment, it is possible to set the endoprosthesis head in a closed way under anesthesia. If the problem starts, the doctor may prescribe a second operation to reinstall the endoprosthesis.

paraprosthetic infection

The second most common phenomenon, characterized by the activation of severe purulent-inflammatory processes in the area of ​​the implant. Infectious antigens are introduced intraoperatively through insufficiently sterile surgical instruments (rarely) or, after intervention, they move along the bloodstream from any problematic organ that has a pathogenic microbial environment (often). Poor treatment of the wound area or poor healing (in diabetes) also contributes to the development and reproduction of bacteria.

Discharge from the surgical wound is a bad sign.

The purulent focus adversely affects the strength of the fixation of the endoprosthesis, causing it to loosen and become unstable. Pyogenic microflora is difficult to treat and, as a rule, involves the removal of the implant and re-installation after a long time. The main principle of treatment is a test to determine the type of infection, long antibiotic therapy, abundant wound lavage with antiseptic solutions.

The arrows indicate the zones of infectious inflammation, this is how they look on the X-ray.

Thromboembolism (TELA)

PE is a critical blockage of the branches or main trunk of the pulmonary artery by a detached thrombus, which was formed after implantation in the deep veins of the lower limb due to low blood circulation resulting from limited leg mobility. The culprits of thrombosis are the lack of early rehabilitation and the necessary medical treatment, a long stay in an immobilized state.

With this complication, they are quite successfully working at this stage of the development of medicine.

The blockage of the lumen of the lungs is dangerously fatal, so the patient is immediately hospitalized in the intensive care unit, where, given the severity of the thrombotic syndrome: the introduction of thrombolytics and drugs that reduce blood clotting, NMS and mechanical ventilation, embolectomy, etc.

Periprosthetic fracture

This is a violation of the integrity of the femur in the area of ​​the leg with an unstable and stable prosthesis, which occurs intraoperatively or at any time after surgery (after a few days, months or years). Fractures more often occur due to reduced bone density, but may be the result of incompetent development of the bone canal before installing an artificial joint, an incorrectly chosen method of fixation. Therapy, depending on the type and severity of damage, consists in using one of the methods of osteosynthesis. The leg, if necessary, is replaced with a more suitable configuration.

Implant failure is very rare.

neuropathy

Neuropathic syndrome is a lesion of the peroneal nerve, which is part of the structure of the greater sciatic nerve, which can be triggered by lengthening of the leg after prosthetics, pressure of the resulting hematoma on the nerve formation, less often by intraoperative damage due to careless actions of the surgeon. Restoration of the nerve is carried out through etiological treatment with the optimal method of surgery or through physical rehabilitation.

When working with an inexperienced surgeon, there is a risk of injury to the femoral nerves.

Symptoms in the table

Syndrome	Symptoms
Dislocation (violation of congruence) of the prosthesis	Paroxysmal pain, muscle spasms in the hip joint, aggravated by movement; in a static position, the severity of pain is not so intense; forced specific position of the entire lower limb; over time, shortening of the leg occurs, lameness appears.
Local infectious process	Severe pain, swelling, redness and hyperthermia of soft tissues over the joint, discharge of exudate from the wound; an increase in the general body temperature, the inability to step on the foot due to pain, impaired motor functions; purulent discharge from the wound, up to the formation of a fistula, is observed in advanced forms.
Thrombosis and PE (thromboembolism)	Venous congestion in a diseased limb can be asymptomatic, which may have an unpredictable detachment of a blood clot; with thrombosis in varying severity, swelling of the limb, a feeling of fullness and heaviness, pulling pains in the leg (increased by load or change of position) are traced; PE is accompanied by shortness of breath, general weakness, loss of consciousness, and in the critical phase - blueness of the skin of the body, suffocation, up to death.
Periprosthetic bone fracture	Acute pain attack, rapidly growing local edema, redness of the skin; crunching when walking or probing the problem area; severe pain when moving with an axial load, soreness of soft structures on palpation; deformity of the leg and smoothness of the anatomical landmarks of the hip joint; impossibility of active movements.
Neuropathy of the tibial nerve	numbness of the limb in the area of ​​​​the thigh or foot; weakness of the ankle (drop foot syndrome); inhibition of motor activity of the foot and toes of the operated leg; the nature, intensity and location of pain can be variable.

Preventive measures

Complications after hip replacement are much easier to prevent than to deal with time-consuming and lengthy treatment to get rid of them. An unsatisfactory development of the situation can nullify all the efforts of the surgeon. Therapy does not always give a positive effect and the expected result, therefore, leading clinics provide a comprehensive perioperative program for the prevention of all existing consequences.

Infections are treated with antibiotics, which in itself is quite harmful to the body.

At the preoperative stage, diagnostics are performed for infections in the body, diseases of internal organs, allergies, etc. If inflammatory and infectious processes, chronic diseases in the decompensation stage are detected, surgical measures will not begin until the identified foci of infections are cured, venous-vascular problems will not be reduced to an acceptable level, and other ailments will not lead to a state of stable remission.

Currently, almost all implants are made of hypoallergenic materials.

If there is a predisposition to allergic reactions, this fact is investigated and taken into account, since the choice of medicines, endoprosthesis materials and the type of anesthesia depends on it. The entire surgical process and further rehabilitation are based on the assessment of the state of health of internal organs and systems, age criteria and weight. In order to minimize the risks of complications after hip replacement to the limit, prophylaxis is carried out before and during the procedure, after surgery, including the long-term period. Comprehensive preventive approach:

• drug elimination of the infectious source, full compensation of chronic ailments;
• appointment for 12 hours of certain doses of low molecular weight heparins to prevent thrombotic events, antithrombotic therapy continues for some time after surgery;
• the use of a couple of hours before the upcoming replacement of the TBS and for several days of broad-spectrum antibiotics that are active against a wide group of pathogens;
• technically impeccable surgical intervention, while with minimal trauma, preventing significant blood loss and the appearance of hematomas;
• selection of an ideal prosthesis design that fully matches the anatomical parameters of a real bone joint, including its correct fixation at the correct orientation angle, which in the future guarantees the stability of the implant, its integrity and excellent functionality;
• early activation of the ward in order to prevent stagnant processes in the leg, muscle atrophy and contractures, inclusion from the first day of exercise therapy and physiotherapy procedures (electromyostimulation, magnetic therapy, etc.), breathing exercises, as well as high-quality care for the surgical wound;
• informing the patient about all possible complications, permitted and unacceptable types of physical activity, precautions and the need to regularly perform physical therapy exercises.

A huge role in successful treatment is played by communication between the patient and the medical staff. This is what is called a service, because when a patient is fully instructed, he better perceives the processes taking place with his body.

The patient must be aware that the outcome of the operation and the success of recovery depend not only on the degree of professionalism of the doctors, but also on himself. After prosthetics of the hip joint, it is possible to bypass unwanted complications, but only with the impeccable observance of the recommendations of specialists.

Endoprosthetics of the hip joints is a surgical intervention, the purpose of which is to replace the affected joint with a special prosthesis. The operation is considered quite complicated, and various complications can often occur after arthroplasty. They may be characterized by pain in the hip area..

Pain almost always occurs after surgery. This is due to the peculiarities of endoprosthetics.

Possible complications causing pain

Complications that can occur after arthroplasty cause severe pain. These include:

1. Rejection of the implant by the body;
2. Penetration of infection into the wound during surgery;
3. Implant displacement;
4. Deep vein thrombosis;
5. bleeding;
6. Change in leg length.

Rejection of the installed prosthesis is rare, since individual tissue sensitivity testing to the material of the prosthesis is usually performed before the operation. In cases where the material is not suitable. It is being replaced and retested. The procedure is performed until the material corresponding to the cells of the body is selected.

When an infection enters the wound, not only pain is observed, but also noticeable swelling and redness of the skin at the site of the suture. To eliminate this complication, antibiotics will be required. The focus of infection may be on the surface of the wound or inside it, for example, where an articular prosthesis is installed.

Displacement of the hip implant may occur due to violations of the activity regimen and recommendations after surgery. For example, it is strictly forbidden to cross your legs or lift them high. Displacement can cause severe pain and discomfort.

Stagnation of blood due to a decrease in motor activity can cause blood stagnation, which develops into deep vein thrombosis. The consequences are not only severe pain, but also the occurrence of such serious diseases as a heart attack, gangrene of the lower extremities.

Bleeding can occur not only during the operation, but also after it. In this case, pain occurs quite rarely.

If the prosthesis is not installed correctly, the muscles that are located in close proximity to the joint weaken. This can cause a feeling of change in leg length and mild pain.

Pain after arthroplasty, which is considered to be the norm

Pain is the only complication after arthroplasty that accompanies the postoperative period in any case. This is due to the numerous muscle incisions that are made to provide access to the joint.

When the tissues grow together, pain occurs in the area of ​​the hip joint, which can last about 3-4 weeks. If you follow the recommendations after arthroplasty and regularly perform the necessary movements, you can achieve the fastest elimination of pain.

What can be done to reduce pain and eliminate it completely?

In order to try to reduce the duration of pain and completely get rid of them, first of all, it is necessary to establish their cause. To do this, you should contact a specialist who will appoint necessary examination replacement of the hip joint, in order to diagnose the causes that caused the pain.

If the pain is provoked by complications of arthroplasty, then their nature of occurrence is clarified and competent treatment is prescribed. In cases where pain is caused by the postoperative period, experts give recommendations for their quick elimination:

1. Follow all the recommendations of a specialist in motor activity and rest after the operation;
2. Perform a complex of therapeutic exercises;
3. Do not make sudden movements, do not raise your legs high and do not cross them;
4. Avoid stagnation of blood in the tissues in the area of ​​the hip joint;
5. Use crutches for the first time;
6. If you experience discomfort and increasing pain in the hip joint, immediately contact a specialist.

Conclusion

In conclusion, we can say that pain after arthroplasty may have a different nature of origin. It is very important to accurately establish their nature and causes.. In cases with postoperative pain, which is a normal manifestation of the body, all the recommendations of a specialist should be followed in order to eliminate them in the near future.

DO YOU STILL THINK IT IS HARD TO GET RID OF JOINT PAIN?

Judging by the fact that you are now reading these lines, victory in the fight against joint pain is not on your side yet ...

Constant or periodic pain, crunching and palpable pain during movement, discomfort, irritability ... All these symptoms are familiar to you firsthand.

But perhaps it is more correct to treat not the consequence, but the cause? Is it possible to get rid of pain in the joints without serious consequences for the body? We recommend reading the article by DOCTOR OF MEDICAL SCIENCES, PROFESSOR BUBNOVSKY SERGEY MIKHAILOVICH about modern methods of getting rid of joint pain... Read article >>

Rehabilitation after hip arthroplasty is one of the components postoperative treatment. Recovery is aimed at normalization muscle tone and lower limb function. The recovery period consists in limiting the load and special gymnastics.

Recovery periods after hip replacement

After hip surgery, the patient must undergo three rehabilitation period: early, late, remote. Each has a specific set of exercises. How long the rehabilitation lasts, it is impossible to say for sure. This period is different for everyone.

Recovery after knee replacement begins at the hospital where the surgery was performed. The patient is in the hospital for two to three weeks. Limb movements can be restored at home or in a rehabilitation center. Further, you can undergo rehabilitation in the clinic of rehabilitation treatment.

In addition to the implementation of the complex exercise therapy exercises daily recovery walks should be taken. Only in this case, the ligaments and muscles will secure the prosthesis in the correct position.

During the recovery period, the operated person is engaged in a rehabilitation specialist or exercise therapy doctor, who will draw up a treatment program suitable for a particular patient. This takes into account age, comorbidities.

Important! Even after total arthroplasty, it is possible to restore the ability to work. The main thing is the strict implementation of medical recommendations and the desire to move.

Early rehabilitation period

The period from the moment of completion of surgery to 1 month lasts.

Goals of this stage

The objectives of the recovery phase are:

1. Improvement of blood circulation in the area of ​​surgical intervention.
2. Prevention of complications (thrombosis, pneumonia complicated by pleurisy, bedsores).
3. Learning to sit up and get out of bed.
4. Puffiness reduction.
5. Healing of the seam in a short time.

Rules of the postoperative period

1. On the first day after the intervention, it is allowed to sleep only on the back.
2. At the end of 1 day after the intervention, you can turn on your healthy side, but only with the help of medical staff. They turn on the stomach 5 days after the operation.
3. You can not make sudden movements, turns in the operated area.
4. Flexion of the limb more than 90 degrees is prohibited.
5. It is forbidden to put the legs together or cross them. A wedge-shaped orthopedic pillow should be placed between the lower limbs.
6. To prevent stagnation of blood in the vessels, it is necessary to perform exercises daily.
7. If the legs swell after the operation, taking diuretics, fixing the limbs in an elevated position, and compresses will help. If the swelling does not go away for a long time, this may indicate complications, dislocation, or an incorrectly selected set of exercises.
8. In the first month and a half, it is advisable not to take hot baths, wash under a warm shower.

Diet after surgery

After the anesthesia wears off, the patient may feel intense thirst or hunger. A small amount of crackers can be eaten six hours after the intervention. Nutrition in the early days should consist of:

1. Meat low-salt broth.
2. Dairy.
3. Oatmeal or mashed potatoes.
4. Kissel or tea.

Charging after arthroplasty

Gymnastics for the calf muscles, buttocks and thighs:

1. Flexion-extension of the fingers of both lower extremities.
2. After recovery from anesthesia, bend and unbend the limb at the ankle. In an hour, do at least six approaches, up to a feeling of fatigue in the muscles.
3. Make rotational movements of the foot clockwise and counterclockwise.
4. Press the popliteal fossa of a healthy limb to the bed as much as possible. Keep the muscles stretched and tense for 15 seconds. On the 5th day of prosthetics, the same exercise can be performed with a diseased limb. Do 10 times with each leg.
5. Tighten the muscles of the buttocks until a feeling of fatigue occurs. Do exercises with each leg in turn.
6. Pull the limb towards you, the foot should slide along the bed. Make movements slowly. Lower. Do 10 times.
7. Take the right limb aside first and return to its original position, and then the left. Do at least 10 times.
8. Place a roll or pillow under the knee joint. Straighten the lower limb, hold it for 7 seconds and return to its original position. Do the same movement with the opposite leg.
9. Straighten and raise the limb to a small height. Lower. Do the same action with the other leg, at least 10 times.

For charging to be useful, you must:

1. Every day, every hour, for 20 minutes, you should perform the gymnastics described above.
2. Do not make sudden movements while exercising.
3. Do not forget about breathing: at the moment of muscle tension, inhale, during relaxation, exhale.
4. To prevent the development of pneumonia, you need to perform breathing exercises.
5. In the first three days, do exercises lying on your back, in the following days - in a sitting position on the bed.

Additional exercises

After the intervention, within 10 days, the doctor teaches the patient to turn on the bed correctly, take a sitting position, get up, use crutches.

When the patient is able to stand up and lean on the operated limb, he must perform the exercises in the initial standing position.

1. Grasp the back of the bed and raise the lower limbs in turn, bending them at the knee. This element of gymnastics resembles walking in place.
2. Holding on to the back of the bed, lift one limb, lifting it. Then lower. Do the same with the other leg.
3. Holding on to the back of the bed, take your leg back and return back. Do the same with the other limb.

It is important to understand that early activation and initiation of rehabilitation reduces the likelihood of developing movement limitation.

Late recovery period

Starts 30 days and ends 3 months after prosthetics.

Goals

1. Increase and strengthen muscle tone.
2. Restoration of movement in the field of prosthetics.

After the patient learns to get out of bed and the duration of walking on crutches exceeds 15 minutes four times a day, classes on an exercise bike can be introduced. . At the same time, the duration of exercises on it should be no more than 10 minutes twice a day.

During this period, you need to learn how to move up the stairs.

When climbing stairs, put your healthy foot on the step first. When descending, first with crutches, then the operated limb, and then the second leg.

remote period

The terms of this period are from three months of setting up an artificial joint and up to six months.

Goals

1. Security normal functioning artificial joint.
2. Improving the condition of muscle fibers, ligaments, tendons.
3. Reduced bone recovery time.

This period is aimed at preparing the patient for more heavy loads, to ensure its normal activity in domestic conditions. In addition to gymnastics, the area of ​​prosthetics is affected by a laser, paraffin, mud, therapeutic baths.

Exercises after arthroplasty at home

Exercises of the early period, which also need to be performed at home, after discharge, need to be supplemented with more complex elements.

1. Lying on your back, take turns pulling the lower limbs to the stomach, performing movements similar to riding a bicycle.
2. Lying on your back, bend your legs alternately and pull them to your stomach with your hands.
3. Lie on your stomach and bend and unbend the limbs at the knees.
4. Lie on your stomach and take the limb back, in turn.
5. Stand up, straighten your spine. Do half squats. At the same time, you need to hold on to something.
6. Place a bar in front of your feet, the height of which should not exceed 10 cm. Stand on it with both feet. Then, in turn, lower the leg: first healthy, and then with a prosthesis. Stand back on the bar in the same sequence. Run at least 10 times.
7. Lean on the back of a chair. On the ankle of the lower limb that has undergone surgery, put on an elastic tourniquet. Tie the other end to something. Pull the operated limb forward. Then turn around and stretch your leg back.
8. Take the leg with the tourniquet to the side and return to its original position. Move at least 10 times. At the same time, you need to hold on to something.

The last two exercises are aimed at restoring movements in the hip joint during its replacement.

Exercises on simulators

In order for the patient to quickly adapt to everyday conditions, he must engage in physiotherapy exercises on simulators. During this period, the muscular and ligamentous apparatus are ready for training in full. In this regard, physical activity can be made more intense.

exercise bike

1. Spin the pedals back. If this action does not require excessive effort, then you can pedal forward. The duration of classes is 15 minutes twice a day, 4 times a week. Over time, the duration of the lesson should be increased to half an hour. It must be remembered that you can not raise your knees above the hips.
2. On the exercise bike, place the pedals at such a height that each leg is fully extended when they are scrolled.

Treadmill

Set the speed to 2 km/h. Stand on the treadmill with your back forward, grab the handrails. Take slow steps back. The leg, at the moment of full contact of the foot with the track, should be straight.

Extension of the hip joint

On a special simulator for extension of the hip joint, focus on a healthy limb. Put the leg with the prosthesis on the roller, which should not be rigidly fixed. In this case, the roller should be located under the femoral region, closer to the knee region. Press on the roller, while bending and unbending the prosthesis will be performed, with the application of effort. The load is provided by a weight attached to the simulator. Over time, the weight of the load must be increased.

Pain after hip replacement

According to reviews, some patients experience pain different localization after hip arthroplasty. It is not always possible to find out why a prosthetic joint hurts. More often pain syndrome associated with instability of the prosthesis or infectious process.

If the leg or knee hurts, the groin, especially when turning the limb or under load, this indicates the instability of the femoral component of the prosthesis.

If the lower back hurts after endoprosthetics, then this may be due to an exacerbation of osteochondrosis associated with the alignment of the limbs after surgery.

Soreness can also develop in the case of an inflammatory process. In this case, the pain syndrome does not depend on movements, the pain gradually increases, the presence of fever and changes in the blood is characteristic. With the instability of the prosthesis, pain occurs only when making a movement.

Conclusion

The entire period of rehabilitation after hip arthroplasty at home should take place under strict medical supervision. You can not do exercises on your own, especially on the simulator. At the same time, exercises must be performed daily, but not through force and pain, as this can lead to serious consequences. If all the recommendations of the doctor are followed, the movements in the joint will gradually recover.

• " News
• » Prevention of radiating pain after hip arthroplasty

In recent decades, total arthroplasty has become one of the main methods of treating pathological changes and injuries of the hip joint, allowing to restore its function, relieve the patient of pain, return to active image life.
But, despite the positive results achieved, there are a number of problems, among which the pain syndrome of the endoprosthetic hip joint occupies a significant place.
According to foreign authors, the pain syndrome in patients undergoing total hip arthroplasty persists in 17-20%, and in 32-35% of operated patients, new pain sensations of varying intensity appear in the absence of signs of instability of the endoprosthesis and infectious process.
In the course of the staff of the RNIITE them. P.P. Harmful analysis of 470 patients operated on the hip joint, using individual questionnaires (from 2 weeks to 12 months), it was found that 68% (320) of patients complain of pain in the area of ​​the operated limb of various localization and intensity - from feelings of discomfort to moderate pain. Of these, the largest specific gravity(about 23% - 74 patients) falls on pain radiating to the knee joint. It should be noted that such pain syndrome occurs most often (70%) in the early postoperative period and may persist for a long time.
As is known from the literature, the region of the knee joint and the fat body of the acetabulum are innervated by the common branches of the obturator nerve. Given the nature and localization of the pain syndrome, it can be assumed that one of the causes of radiating pain in the knee joint after hip arthroplasty is irritation of the small branches of the obturator nerve in the area of ​​the fat body.
Based on this, the authors developed a method for the prevention of radiating pain in the knee joint by intraoperative excision of the fat body and injection of a local anesthetic solution (S. Lidocaini 2% 5 ml) into its stump under the transverse ligament directly to the fibers of the branch of the obturator nerve, causing its irreversible blockade.
Currently known methods of blockade of the obturator nerve, unfortunately, do not have the desired effect in this situation, they are short-term and reversible.
The disadvantages of the known methods is the manipulation blindly, paraneurally, according to bone landmarks, during which trauma to the neurovascular bundle is possible and the procedure is painful for patients.
The developed method is based on the studies of Japanese and American scientists, who proved that the introduction of an anesthetic of a certain concentration directly into the nerve fibers leads to an irreversible violation of the properties of impulse conduction.
The authors conducted a study on 84 patients aged 35 to 60 years with various lesions of the hip joint (coxarthrosis, aseptic necrosis, false joint), received by the RNIITE them. P.P. Damaged in 2007-2009. for the purpose of endoprosthetics. They were divided into main and control groups of 42 patients. All the studied patients had no signs of gonarthrosis and pain in the knee joint before the operation.
Patients of the main group underwent hip arthroplasty using the method developed by the authors for the prevention of postoperative pain radiating to the knee joint: after processing the acetabulum with cutters, a complete excision of the fat body and own ligament of the femoral head was performed. Using a sterile syringe, 5 ml of S. Lidocaini 2% was injected under the transverse ligament into the stump of the fat body. Thus, the effect of irreversible blocking of the fibers of the branch of the obturator nerve was induced. Subsequently, the acetabular component of the endoprosthesis was installed and the standard course of the operation continued.
Patients in the control group underwent standard arthroplasty.
In all patients, the postoperative period was uneventful, the wounds healed by primary intention.
The results were evaluated in the early and late postoperative periods using individual questionnaires, where patients independently noted the localization of pain, the relationship with the load before and after surgery. The intensity of the pain syndrome was studied using visual analogue scales reflecting the color and emotional state patient.
In the main group, 41 patients (97.6%) had no complaints of pain in the knee joint after surgery. In 1 patient (2.4%), pain in the knee joint radiating to the lower leg and foot, similar to sciatic neuralgia, was detected, associated with lengthening of the operated limb.
In the control group, 10 patients (23.8%) had isolated pain in the knee joint at various times after surgery. It should be noted that the intensity of the pain syndrome is most pronounced during the first two weeks and can persist up to 3 or more months after surgery.
Thus, the authors revealed the high efficiency of their proposed method, characterized by painlessness, accuracy of intraoperative administration of the anesthetic and the irreversibility of the analgesic effect.
The proven clinical efficacy of the developed method allows us to recommend its use in practice in order to increase the efficiency of arthroplasty and significantly improve the quality of life of patients.

News posted Korshunov Anton Viktorovich, company spinet

New medical discoveries have made it possible to restore the activity of the lower extremities due to hip replacements. This procedure helps to get rid of debilitating pain and discomfort, restores the functioning of the legs and helps to avoid disability. But sometimes there are different kind complications after hip arthroplasty. Pathologies can develop due to a medical error, infection, non-engraftment of the prosthesis, improper restoration procedures.

Common complications after hip arthroplasty

The operation to replace the hip joint of patients with an artificial one has been carried out for more than thirty years with great success. Such an intervention is especially in demand after hip (neck) fractures, damage to the musculoskeletal system, when the cup wears out due to age-related changes. Regardless of the cost of hip replacement surgery, complications are rare. But with untimely treatment of problems, the patient is threatened with disability, immobility of the lower extremities, and with pulmonary embolism (thromboembolism) - death.

Conventionally, all the causes of the consequences and difficulties of the postoperative period after such prosthetics are divided into several groups:

• caused by non-perception of the implant by the body;
• negative reaction to a foreign body;
• allergy to the material of the prosthesis or anesthesia;
• infection during surgery.

Complications after prosthetics negatively affect not only the thigh area, but also affect the general physical, psychological state, physical activity and walking ability. To restore the former health, it is necessary to undergo a series of rehabilitation measures, which are prescribed based on the developed pathologies and problems. For a quick and effective recovery, it is necessary to establish the causes of complications and restrictions after surgery.

General complications

The development of the medical industry does not stand still, every year there are hundreds of discoveries that can change lives, give a chance to many patients. But complications after surgery are not uncommon. During prosthetics, in addition to specific difficulties, there may be common pathologies:

• Allergy to medications that were used before or during surgery. For example, anesthesia.
• Deterioration of the work of the heart muscle (an operation is always a burden on the heart), which can provoke attacks and diseases of the cardiovascular system.
• Violation of motor activity, which is provoked by the non-perception of a foreign body by the body or an allergy to the implant material (for example, ceramics).

Infection in the area of ​​operation

Quite often, during an arthroplasty operation, such a complication occurs as infection of the soft tissues at the site of the incision or the implant itself. What is the danger of an infectious lesion:

• There are severe pains in the field of surgical intervention and placement of the endoprosthesis.
• At the site of the incision, suppuration, swelling and discoloration of the skin are observed.
• Septic instability of the new joint can become critical, which leads to a violation of the motor function of the lower extremities.
• The formation of a fistula with purulent discharge, which is especially often observed if timely treatment is not started.

So that complications after prosthetics do not nullify the efforts during the operation, it is necessary to select and start treatment in a timely manner. Taking special antibiotics and using temporary spacers (implants) will help get rid of the infection. The treatment process will be long and very difficult, but the result will please the patient.

Pulmonary embolism

by the most dangerous complication, which can develop after the installation of an artificial joint (endoprosthesis), is pulmonary embolism. The formation of blood clots is often provoked by the immobility of the leg, which leads to impaired blood circulation in the lower extremities. This disease often ends in death, so you need to take preventive measures, for example, take anticoagulants, which the doctor prescribes for several postoperative weeks.

blood loss

Bleeding may occur during hip replacement surgery or shortly thereafter. The reasons are a medical error, careless movement or abuse of medications that thin the blood. In the postoperative period, anticoagulants are prescribed to prevent thrombosis, but sometimes such caution can play a role. a cruel joke turning preventive measures into a source of trouble. The patient may need a blood transfusion to replenish supplies.

One of the complications after prosthetics is dislocation of the head of the prosthesis. This complexity is caused by the fact that the endoprosthesis is unable to completely replace the natural joint and its functionality much lower. Falls, improperly performed rehabilitation, performing complex exercises or sudden movements can provoke a dislocation, which will lead to complications. As a result, the work of the musculoskeletal system, the activity of the lower limb will be disrupted.

To avoid complications after arthroplasty, one should be extremely careful in movements in the postoperative period: one should not turn the leg inward too much, its flexion in the hip joint should not be more than 90 degrees. Revision hip arthroplasty will help to eliminate the complication, and for complete healing, it will be necessary to completely immobilize the leg for some time.

Loosening of the endoprosthesis design

As a result vigorous activity, movements of the legs, loosening of the artificial joints occurs. This negatively affects the condition of the bone tissue. Loosening causes destruction of the bone where the endoprosthesis is inserted. Subsequently, such instability of the prosthetic site can lead to a fracture. The only option to prevent loosening is to reduce motor activity, and to eliminate the problem that has already appeared, revision arthroplasty of the hip joint is used.

Lameness

Lameness is a common complication after hip arthroplasty. Such a pathology can develop as a result of some cases:

• Patients who have had a broken leg or femoral neck often experience shortening of one leg after hip replacement surgery, resulting in lameness when walking.
• Long-term immobilization, the state of rest of the lower limb can provoke atrophy of the leg muscles, which will cause lameness.

Surgical intervention will help to get rid of the complication, during which bone tissue is built up to equalize the length of the legs. Patients and physicians resort to this option extremely rarely. As a rule, the problem is solved by using special insoles, linings in shoes or wearing special shoes with different heights of soles and heels, which are sewn to order.

Groin pain

A rare complication after hip arthroplasty is pain in the groin area from the surgical intervention. The resulting pain may be backlash organism on the prosthesis, allergic to the material. Pain often occurs when the implant is positioned anterior section acetabulum. To get rid of the pain syndrome and get used to the new joint will help the implementation of special physical exercises. If this does not bring the desired result, revision arthroplasty will have to be performed.

Swelling of the legs

After surgery, as a result of keeping the leg at rest for a long time, such a complication as swelling of the lower extremities is often observed. The blood flow, metabolic processes are disturbed, which leads to swelling and pain. Taking diuretics, keeping your legs elevated, using compresses that relieve swelling, as well as regular simple exercises will help get rid of such a problem.

Physiotherapy

To get rid of complications after hip arthroplasty, and to make the rehabilitation process as quick and painless as possible, it is necessary to regularly perform physical exercises prescribed by the doctor. Thanks to simple actions, the motor activity of the new artificial joint develops, the patient returns to the ability to move with his legs without the use of crutches.

A set of exercises for recovery after arthroplasty is selected individually. It takes into account the following factors:

• patient's age;
• activity of the lower limb where the joint was replaced;
• the general health of the patient;
• psychoemotional state of the patient.

When performing physical exercises and while walking, it is important to remember that after surgery, patients are strictly prohibited from:

• crossing legs;
• flexion of the lower extremities in the hip joint by more than ninety degrees;
• twisting the leg to the side.

To make rehabilitation more effective, perform a set of exercises:

1. Take a supine position (a firmer surface is ideal - an elastic mattress or floor), alternately perform a series of simple exercises:

• Bending the legs at the knee joint without lifting the foot from the surface.
• Abduction of the lower extremities to the side (alternately with a leg with an artificial and a natural joint).
• Bike. Raise your legs slightly up and perform movements that mimic riding a two-wheeled pedal vehicle.
• Alternate straightening and return to the bent position of the legs bent at the knees.

1. Change position by turning onto your stomach. In this position, do the following exercises:

• Flexion and extension of the knee joint.
• Raising the leg up.

1. Lying on your side, lift the straight lower limb up, and then take it to the side. Repeat the same exercise on the other side.
2. In a standing position, swing your legs forward, backward and abduct the lower limb to the side.
3. When performing this complex, do not make sudden movements so that the cup of the joint does not pop out, loosen, causing all sorts of complications and pain.

Rehabilitation centers and cost

For rehabilitation and getting rid of complications after arthroplasty, people often choose clinics abroad, preferring sanatoriums or clinics, for example, in Germany, Israel. But on the territory of Russia there are also medical centers where it is possible to undergo recovery after surgery, to cure the pathologies that have arisen after it. There are such clinics in major cities of the country, for example, Moscow, Voronezh, St. Petersburg, where qualified doctors work who can assist in rehabilitation.

The cost of rehabilitation measures after hip arthroplasty in different sanatoriums may differ depending on many factors:

• Location of the hospital. In sanatoriums located in picturesque corners, the price per day will be much higher than in clinics located on the outskirts of the city.
• Services provided in the clinic. The larger the list of procedures, the higher the cost. Particularly relevant are massage, exercise therapy, classes on special simulators (for example, an exercise bike).
• The comfort of the wards or rooms directly affects the price of living in rehabilitation centers.

Sanatoriums, clinics and the cost of rehabilitation after hip arthroplasty in Moscow and St. Petersburg:

Name of the sanatorium, clinic	Hospital address	Cost of living for 1 person/day, in rubles
Treatment and Rehabilitation Center	Moscow, Ivankovskoe highway, 3
Clinic "K+31"	Moscow, st. Lobachevsky, 42 bldg. four
Central Institute of Traumatology and Orthopedics. N. N. Pirogova, Federal State Unitary Enterprise	Moscow, st. Priorova, 10
Sanatorium "Dunes"	Primorskoye Highway, 38 km, St. Petersburg	For recovery after endoprosthetics, methods are used, the effectiveness of which has been proven by many patients: Specialized therapeutic massage aimed at post-operative recovery, relieving pain that has arisen after surgery. Electrotherapy - removes pain and promotes rapid recovery. Laser therapy is a procedure that has a beneficial effect on the postoperative suture. Magnetotherapy - promotes tissue regeneration in the area of ​​surgical intervention. The adoption of thermal waters, which contributes to the rapid recovery of the joints, improves their mobility and reduces pain. Therapeutic gymnastics, exercise, which is carried out to improve the motor activity of the leg, depending on the physical, psychological and emotional state of the patient, and is prescribed after a thorough examination. To obtain the maximum result, it is necessary to use all methods in combination. Watch the video to learn more about the methods of dealing with the consequences after arthroplasty:

The main reason for the appointment of knee arthroplasty is persistent pain and the inability to move independently. The decision to operate is made by the doctor and the patient if conservative treatment fails. Any intervention, even if it is performed by an experienced orthopedic surgeon, is stressful for the body. A wound, even properly treated and sutured, reacts to an aggressive invasion with pain, swelling, and infectious diseases.

If your knee looks like this, it's time to sound the alarm.

After the operation, the pain sensations will eventually go away, “take root” and cease to be felt as foreign body the inflammation will subside. For this, inpatient observation and enhanced drug treatment are recommended for the first time. Further "home" rehabilitation depends on the efforts of a person, his desire to start a full life, self-confidence, a positive attitude towards speedy recovery. If painful symptoms appear longer than a month after discharge from the hospital, a visit to the orthopedist is mandatory.

Often by the seam you can judge how the joint takes root. There is no well-established implant and at the same time a poorly healing suture. And vice versa: there is no good seam without an inflammatory process in the bone.

Sometimes the suture is crooked, but this does not mean that the surgeon was inexperienced. Often this is due to the vessels that have to be “bypassed” during the operation.

Counting on an instant miracle is wrong. Pain for the first time after surgery is normal, no need to panic. The body simply adapts to new conditions. In order to stop painful sensations, to return the natural kinematics, rehabilitation measures are carried out, both in a hospital setting and after discharge.

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

Types and signs of postoperative complications

Problem	Symptom
infectious inflammation	Fever, redness in the knee area
	Restriction of flexion / extension, up to complete immobility
	In this case, the main thing is not to confuse sanovitis with infectious inflammation, because the treatment tactics are completely different. Recovery for each proceeds individually; depends on 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, it is possible to prescribe a course of further rehabilitation. Inflammation After the operation, the muscles or tissues around the endoprosthesis may become inflamed. In 4-11% of cases, infectious processes lead to implant revision. Most often, this phenomenon is observed in patients with or who have undergone. In rare cases, the causes of infection are a violation of sanitary standards in the operating room, the use of a low-quality implant and suture material. Before you read the reviews of people who did the replacement in this hospital. X-ray of an infected knee joint. Try to guess: what is superfluous in this picture? The development of the infectious process is provoked by malnutrition, overweight, the presence of immune diseases, alcohol consumption, diabetes and oncology. Immunosuppressants and corticoids are contraindicated as treatment - they increase the risk of infection. Signs of inflammation: steadily elevated, but not too high body temperature (rises more strongly in the evening); the leg does not work well, it hurts and swells; local redness; sometimes discharge of pus from a wound or joint. If something is wrong with the knee, the first sign is pain and fever in the area of ​​the implant. 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 late postoperative period you have a question: why is the knee hot and sore, most likely it is a late hematogenous infection in the implant area. To stop the pain, and even more so to prescribe antibiotics for yourself, is categorically contraindicated. Only an orthopedic surgeon can prescribe antibiotics, prescribe anesthesia and suggest which ointment to use after the examination. Failure to comply with medical recommendations is fraught with revision knee arthroplasty. Re-dislocation or fracture The implant is installed in the place of the damaged joint with an accuracy of up to a millimeter. With the help of computer visualization, the kinematics in the flexed/extended position is checked. 1-1.2% of cases end in re-dislocation or fracture of the endoprosthesis. In rare situations, the problem is caused by improper installation or poor-quality prosthesis, 98% of patients create a problem for themselves by ignoring rehabilitation recommendations. This happens when an injury is received, a person, for example, falls. This is where revision surgery is needed. The main symptom of a fracture is a crunch inside the knee joint. If at an early stage such a symptom can be explained by a medical error or a postoperative complication, then in the future, a crunch indicates an increase in scar tissue. Improper recovery is due to non-compliance with the regimen and diet. When a crunch appears, do not expect further complications. Contact a specialist to correct defects. Often you can get by with a therapeutic effect, avoid revision. Knee arthroplasty: complications and recommendations A month after knee arthroplasty: "home" rehabilitation The home environment is relaxing - this is its danger. In order for the recovery to proceed correctly, there is no need to go to extremes: inactivity and vigorous activity are equally harmful. By adhering to medical recommendations, you will ensure a successful rehabilitation for yourself, save the endoprosthesis. The warranty period for the operation of an artificial joint is 10 years, but under improper loads, the elements wear out faster. Gymnastics for the first month: Print the picture and keep it as a guide. Under current legislation, a disability certificate is issued for 15 working days. If you work with physical exertion or being on your feet, it is better to go to the hospital at your place of residence to extend the sick leave. To make a decision, a special commission will be assembled, which, after reviewing the medical history, will issue a verdict - whether to extend the sick leave, for how long. The maximum period of validity of the commission's decision is 10 months. If the disability certificate needs to be extended for a year, another council is going to. The timing depends on the characteristics of the organism, it may be necessary to travel to a sanatorium or hospitalization to identify signs of implant instability. Failure to comply with the recommended exercise therapy is the reason for the refusal to extend the sick leave. 5 months after discharge, you can start training on special simulators, return to an active lifestyle. If during this period you are still worried about pain, consult an orthopedist. Most likely, the matter is in the pathological process. Disability after knee arthroplasty Most people assume that joint replacement provides disability. This is not true. Implantation, on the contrary, guarantees the restoration of normal mobility. A person returns to active life in six months, forgetting about the pain. The group after the operation is awarded with the ineffectiveness of arthroscopy and the progression of the disease: at least stage 2; arthrosis with deformity of the leg (curvature, shortening); prosthesis of articular segments on both limbs with unforeseen consequences or deviations. No disability is allowed: the operation is done just so that the patient does not become disabled. A person agrees to endoprosthetics in order to maintain independence, therefore, with a normally performed operation and without pronounced disorders of the musculoskeletal functions, disability is not assigned! To prevent the development of pathologies, the first 3 weeks after implantation, the patient constantly wears compression stockings. The level of compression is determined by the attending physician based on the results of the examination. The effectiveness of the early stage of rehabilitation also depends on the choice of crutches. Good handy tools with support under the elbow reduce the load on the sore leg, providing peace and proper blood flow. Underarm crutches are very compact and mobile compared to conventional axillary crutches. Which crutches are best suited, the doctor decides. The height, weight of the patient, anatomical features are taken into account. With absence pain the axial load gradually increases, in the future a cane is used. Try classes on the step machine - it is soft and effective. Classes on simulators, swimming, walking in the fresh air, a balanced diet are the key to the success of treatment. Listen to yourself, control the state of the body. Feel free to disturb the doctor, then you can do without revision.