Reviews about hip replacement

The left hip joint (not on the right in the picture) no longer functions.
Endoprosthetics is a surgical intervention that is required for a person with severe destruction of the hip joint. This is the only way to return to an active lifestyle, perform your professional duties and even play sports. According to patient reviews, only after hip replacement were they able to completely get rid of pain at rest and when walking, lameness and morning stiffness.

Features of endoprosthetics

In case of severe damage to the hip joint (HJ) by inflammatory or degenerative pathology, conservative methods are ineffective. A person gradually loses the ability to move independently. And it is impossible to get rid of pain for a long time even with the help of potent analgesics. In such cases, patients are indicated for endoprosthetics - replacement of the destroyed hip joint with an implant.

At the stage of preoperative preparation, the patient takes medications prescribed by the surgeon and does physical therapy and gymnastics. By strengthening muscles and replenishing vitamins and microelements, postoperative complications can be avoided. The rehabilitation doctor teaches the patient in advance how to walk on crutches, rise from sitting and lying positions, and deep diaphragmatic breathing skills.

The operation does not last long, and a long rehabilitation period begins immediately after it. The patient constantly exercises the operated leg, walks a lot to form the lost correct motor stereotypes. After about 3-4 months, the functional activity of the hip joint and leg is completely restored.

4. Personal experience

In my early years as an orthopedic surgeon, revision surgeries were rare. As rare cases, they always attracted my attention and aroused interest, so participation in such operations has always been a priority for me.

By assisting professors and associate professors, I gradually acquired certain experience, and by analyzing scientific data from the literature and conference materials, I became acquainted with modern achievements in revision surgery.

Since 2007, I began performing revision surgeries on my own, and in recent years I have had to do 30-40 revision surgeries a year.

Advantages and disadvantages

Like any surgical intervention, hip replacement has its advantages and disadvantages. Thanks to innovative technologies, operations are increasingly being performed using minimally invasive methods, with minimal damage to the skin and underlying soft tissues. The postoperative suture after such an intervention is small. It heals quickly, leaving no scars or scars on the skin.

But the main “advantage” of endoprosthetics is the elimination of pain, swelling, and limited mobility that precede complete immobility. After surgery performed using a minimally invasive method, the patient’s recovery is much faster. What can be attributed to the disadvantages of endoprosthetics:

• risk of postoperative complications;
• long period of rehabilitation;
• the need to replace the endoprosthesis after 10-15 years.

Another “minus” is the relatively high cost. After contacting regional authorities, the patient is put on a waiting list for free endoprosthetics. But the operation is in demand, and you have to wait a long time for a call. Therefore, many patients prefer to pay for the installation of an artificial joint themselves in clinics in Russia, the Czech Republic, and Israel.

Where can you have joint replacement surgery in Russia?

Among the cities that lead in the quality and quantity of interventions carried out, the leaders are:

• Moscow;
• Saint Petersburg;
• Kazan;
• Ekaterinburg;

Many clinics operating in Russia have international status. The number of highly qualified specialists in orthopedics and surgery is growing every year. This is also affected by changes in educational programs at universities. The availability of foreign implant manufacturers makes it possible to find the necessary prosthesis easily and quickly. Rehabilitation products are also becoming more accessible. Therefore, many patients are happy to choose Russian clinics. After all, even the absence of a language barrier is a serious argument.

Why endoprosthetics may be required

Orthopedists, rheumatologists, and traumatologists always take into account the likelihood of postoperative complications, so they often try to cure the pathology that affects the hip joint using conservative methods. Such therapy is not always successful, and surgery is recommended for the patient. In what cases is endoprosthetics indicated:

• coxarthrosis - deforming osteoarthritis of the hip joint;

• aseptic necrosis of the femoral head;
• dysplastic coxarthrosis;
• femur fractures;
• formation of false joints;
• deformation of the acetabulum after injury;
• chronic forms of arthritis, including rheumatoid polyarthritis;
• Bekhterev's disease with damage to the hip joint;
• complete or partial immobilization of the joint - ankylosis;
• non-united femoral neck fractures.

Irreversible changes in the hip joint are typical for pathologies of grade 2-3. If the hip joint is severely damaged, doctors recommend not wasting time on futile conservative treatment, but immediately installing an endoprosthesis.

On the left is the healthy surface of the joint, on the right is the one affected by arthrosis. After making the decision to undergo surgery, you will need to undergo a series of diagnostic measures to identify contraindications.

About expectations from surgery, prosthetics and specialists

Endoprosthetics will be successful if the correct choice of a specialized domestic or foreign medical institution is made. Its staff must be staffed by highly qualified surgeons who perform complex operations on a daily basis. Good clinics always have experienced rehabilitation doctors who will help the patient quickly recover the operated leg. It is necessary to spend a sufficient amount of time studying the reviews of people who have undergone hip replacement.

Consultations with clinic specialists and a conversation with a surgeon are required. After studying the diagnostic results, additional studies may be required to determine the type of implant the patient needs. Endoprostheses consist of the following components:

• a cup that replaces the acetabulum of the pelvic bone. The part is made of ceramics or polymer material;
• a metal spherical head coated with a layer of ceramics, ensuring smooth sliding of other structures of the artificial joint when walking;
• metal leg imitating the neck and upper third of the femur.

The materials used in the manufacture of the endoprosthesis are quite inert and compatible with the tissues of the human body. Previously, unipolar endoprosthesis replacement was often practiced. This is the name of the operation, during which only the destroyed head of the femur is replaced. Due to the high probability of further damage to the acetabulum, bipolar prosthetics have recently been resorted to. An implant is installed that replaces all parts of the hip joint. These prostheses are securely fixed in the bone structures and perfectly adapt to subsequent loads during movement.

Features of the operation

The purpose of any revision arthroplasty operation is similar to the purpose of the primary operation. That is: relieve pain, restore normal function of the joint, ensure supportability (in the case of the joint of the lower limb), etc.

However, the surgeon is faced with much more complex tasks:

• remove the existing endoprosthesis in the most careful and least traumatic way possible;
• ensure high-quality fixation of the endoprosthesis under normal conditions. bone deficiency;
• minimize the likelihood of dislocation in the joint (during revision operations, the frequency of dislocations is much higher);
• sanitize tissues from friction wear products or infections;
• select the most suitable revision endoprosthesis;
• THE MAIN THING is to be prepared for any change in the course of the operation and have optimal solutions ready!

That is why revision operations are considered significantly more complex and require increased attention and dedication from the surgeon and all staff!

Characteristic difficulties

During revision operations, surgeons face the following difficulties:

• removal of cement from the bone (with cement fixation of the endoprosthesis);
• removal of stable, well-attached implants with minimal removal of healthy bone;
• prevention of intraoperative bone fractures;
• assessment of the compatibility of endoprosthesis components from different manufacturers and models if partial replacement is necessary.

Performing a revision operation from the point of view of an orthopedic surgeon is similar to a game of chess, during which it is necessary to foresee the possible development of the situation several moves ahead and, most importantly, have ready-made solutions for most possible difficulties.

That's why revision surgeries are performed by the most experienced specialists.

Postoperative regimen

The features of the postoperative regimen very much depend on which joint it was performed on, what was the reason for the revision, what endoprosthesis was installed and what method of its fixation. The recovery regimen, therefore, is compiled individually for each specific patient and it can be the same as after the primary operation, and very long, with the use of special rehabilitation means.

results

The result of revision arthroplasty, in case of successful operation and a correctly selected rehabilitation regimen, does not differ from the result of primary arthroplasty - normal movements in the joint are restored (sometimes with some restrictions), the ability to support the leg or the normal functioning of the arm.

Methods for fixing endoprostheses

The effectiveness of surgical intervention is influenced not only by the type of endoprosthesis, but also by the method of its fixation. After all, both the service life and the quality of service, including performing the functions of support and providing the necessary range of movements, depend on how firmly it adheres to bone tissue.

The issue of prosthesis quality worries many patients. There are no very bad ones. Better choose a good doctor.

Despite the fact that the method of fixation is determined in advance, the surgeon may change his mind when examining the surgical field.

The disadvantage of cement fixation is the high temperature when the biological glue hardens. Under its influence, bone tissue can be damaged, and the endoprosthesis can move towards the pelvis. The advantage of this method of fastening is faster patient rehabilitation than with cementless fixation. Therefore, surgeons often prefer a combination of cemented and cementless methods of endoprosthetics.

Hip replacement

MEDSI has all the necessary material resources to carry out high-tech operations. We cooperate with leading foreign manufacturers of prostheses, and our surgeons are highly professional specialists who perform several dozen such interventions every month.

When is endoprosthetics necessary?

The operation is indicated for significant destruction of the joint, when it is impossible to restore it using other methods. It is carried out when:

• Fractures of the surgical neck of the femur
• Aseptic necrosis of the femoral neck
• Malignant neoplasms in the hip joint
• Coxarthrosis of severe degrees
• Joint destruction due to systemic diseases

Choosing a prosthesis

There are several types of hip joint prostheses, depending on the materials they are made from. It often happens that two parts of one product (artificial joint head + glenoid cavity) are made of different materials.

To designate parts of the prosthesis that will contact each other during movements, the concept of “friction pair” is used. A friction pair is individually selected for each patient based on considerations of cost, purpose of the operation, expectations for the service life of the product and other factors.

Couple "ceramics-ceramics"

: wears out slowly, lasts a long time, does not cause allergies, is resistant to different types of loads. Wear products formed over time are neutral for the body. The latest generations of prostheses have increased resistance to sudden impulse loads and dislocations. Suitable for all patients, even those who plan significant physical activity. The most expensive type of prosthesis.

Metal-to-metal pair

: resistant to any types of loads and damage, wears out slowly, allows for wide range of movements in the “new” joint. This pair is good for people who are going to lead an active lifestyle and plan to play sports. Optimal for men.

Metal-polyethylene pair

: service life is somewhat shorter than others; such prostheses are less suitable for loads. For this reason, they are most often chosen by elderly patients who do not plan to move much and who are quite satisfied with the rather modest reserves of such a prosthesis. In the most modern models made of polyethylene, the strength of the material has been greatly increased, which is why many patients choose these prostheses.

Other types of friction pairs are used less frequently.

Preparation for hip replacement

Before surgery, the patient undergoes a fairly large amount of examinations. First of all, the condition of the hip joint is assessed, the need for surgery and the possibility of alternative treatment are determined. Possible contraindications are identified.

After making sure that the operation is possible, the doctor, together with the patient, selects an endoprosthesis. Next, the patient undergoes a preoperative examination. The standard list of tests and studies includes an ECG, a general blood test, a general urinalysis, a biochemical blood test, blood tests for coagulation, and infections (HIV, viral hepatitis, syphilis).

Before the operation, it is important to ask the surgeon all the questions of interest, for example: what can and cannot be done after the operation, what is the frequency of complications after such interventions, what should the patient do for the most favorable treatment outcomes.

How is the operation performed?

In the operating room, a catheter is installed in the patient’s vein, through which drugs are supposed to be administered or, if necessary, blood is transfused during the intervention. He is then placed under anesthesia or given spinal anesthesia.

The surgeon makes an incision and carefully accesses the joint, avoiding damage to surrounding structures. Next, the affected part of the joint is removed. An endoprosthesis is installed in place of the removed components using cemented (using methyl acrylate cement) or cementless (using screws) techniques. Next, the function of the limb is checked, and the surgical wound is sutured.

In general, the operation lasts 1.5-2.5 hours.

Rehabilitation after surgery

The patient remains in intensive care for several hours after the operation. This precaution is necessary so that staff can quickly respond to possible complications. Despite the fact that the operation is performed using minimally invasive techniques with minimal risk of complications, a short stay in intensive care is mandatory according to the standard.

Next, the patient is transferred to the ward, where rehabilitation begins from the first day after the operation. After a few days, the person is discharged from the hospital and transferred to a sanatorium for further treatment.

Advantages of hip replacement at MEDSI

• Unique foreign-made endoprostheses from premium manufacturers, manufactured on a 3D printer
• – if necessary, the attending physician involves doctors of related specialties in the treatment
• Early mobilization after surgery
• Full cycle of treatment and rehabilitation, management until complete recovery
• Fast-track surgery: treatment and recovery in a short time
• Possibility of free treatment under the compulsory medical insurance policy*, as well as under high-tech assistance programs

* About the possibility of receiving treatment under the compulsory medical insurance policy, the list of diagnoses and the number of quotas, check with your attending physician.

What happens during surgery

The initial stage of endoprosthetics is pain relief. Epidural anesthesia and general anesthesia are used. For elderly patients suffering from chronic pathologies, the first method is preferable. Under epidural anesthesia, a person is fully conscious but does not feel any pain. He hears the tapping of hammers, the sound of a drill, and the conversations of surgeons installing an endoprosthesis.

After accessing the surgical field, the doctor opens the joint capsule, brings out the head of the femur and performs its resection. After modeling the bone, the surgeon processes the acetabulum, removing any remaining cartilage. At the final stage of the operation, the implant is fixed, sutured, and active suction drainage is installed.

Possible complications

Complications after replacing the hip joint with an implant are quite rare.

Sometimes an infectious process develops with the accumulation of purulent exudate due to the penetration of streptococci, staphylococci, pathogenic fungi, and activation of herpes viruses into the postoperative wound. There may be a blockage of a blood vessel by a thrombus, impairing blood circulation in a certain area of ​​the leg. To prevent such complications, patients use antiseptics when treating sutures; antibiotics and anticoagulants are taken orally.

To prevent thrombosis, you will need to take blood thinning medications for a month after surgery.

Cost of the operation

The cost of the operation is set by a domestic or foreign clinic. It is calculated individually, taking into account the severity of the pathology, the price of the endoprosthesis and the materials used during the operation:

• single-pole endoprosthetics - from 25,000 to 240,000 rubles;
• primary total hip replacement - from 23,000 to 250,000 rubles;
• revision hip arthroplasty - from 20,000 to 350,000 rubles;
• closed reduction of a dislocated endoprosthesis head - from 4,000 to 25,000 rubles.

The cost of laboratory and instrumental tests and daily stay in the medical center are also taken into account. The price will increase if rehabilitation takes place in this clinic rather than at home.

How to choose a clinic

Joint replacement determines a person’s future quality of life. The choice of a doctor and clinic must be approached with the utmost seriousness.

It is necessary to evaluate the following clinic parameters for endoprosthetics:

• availability of reviews;
• the duration of the clinic's existence;
• level of qualification of doctors (it is desirable that they have a degree);
• the city where the clinic is located;
• availability of rehabilitation specialists in the hospital and means to carry out activities;
• the popularity of the brands they recommend when choosing implants;
• the presence of a website with a large content, where you can get acquainted with the procedures, costs, and contact details of the clinic;
• the presence of external awards, incl. supervisory organizations;
• warranty obligations;
• length of stay in the hospital;
• technologies used during the operation and types of anesthesia;
• cost of services (a price that is too low should be alarming, because complex surgery and an implant designed to last 10 years cannot be cheap), etc.

Regardless of how much a hip replacement costs in Russia, the rehabilitation process and stability of the prosthesis largely depends on the patient. You should follow all the doctor’s recommendations, monitor the correct performance of rehabilitation exercises and gait so that the implant takes the desired position and repeat surgery is not required.

Reviews from experts

According to doctors, the vast majority of patients are satisfied with the results of surgical treatment. All functions of the hip joint are restored, and the limping, shortening of the limb, and limitations in abduction and internal rotation of the hip that are characteristic of its damage disappear. Further rehabilitation with a gradual increase in loads helps to put in order the previously atrophied muscles of the thigh, buttocks, and lower legs. After installation of the prosthesis, the likelihood of bilateral damage to the hip joint due to improper redistribution of loads is reduced.

Patient reviews

Endoprosthesis replacement is often the only way to get rid of pain that occurs during the day and night, and gets worse when walking. Now patients indulge in long walks in the fresh air, travel, and gardening.

The only restrictions are those sports and movements that involve forceful loads on the operated leg. Due to long-term exercise therapy and gymnastics, not only the physical but also the psychological state of former patients is normalized. Their ligaments and muscles become stronger, and as a result of improved blood circulation, many chronic diseases recede.

In what cases should the clinic refuse intervention?

If there is a risk of rejection of the prosthesis or death of the patient and deterioration of his condition, the orthopedic doctor and the hospital itself may refuse endoprosthetics. This should not be a reason to start looking for someone else who will take on the process. It is better to try to reduce the existing risks.

Most often they are associated with:

• exacerbation of chronic diseases;
• poor heart and kidney function;
• the presence of blood clots;
• low hemoglobin levels and increased white blood cell levels;
• existing tissue inflammation;
• the presence of acute respiratory infections and other colds.

Many of these causes can be eliminated. Then the question of possible arthroplasty can be raised again. But if you want to solve your problems efficiently and forever, contact us and we will tell you in detail what the Czech Republic has to offer for recovery.