Hip replacement

A dual mobility prosthesis looks like this: one implant head is fixed into the other. That, in turn, is placed in a metal cup. This design reduces the likelihood of dislocation and allows for a greater range of motion. The system is recognized as one of the most reliable options for revision surgery. Well suited for elderly patients with weakened muscles and cognitive dysfunction. Global brands produce lines with a variety of sizes of endoprostheses. The selection of the ideal one is carried out based on X-ray images of the joint; the final decision on which components of the implant to install is made directly during the operation.

How is hip surgery performed?

During total arthroplasty, after gaining access to the joint, the surgeon prepares the acetabulum, into which he then installs a cup and liner, fixing it with screws if necessary. After this, in most cases, the head and neck of the femur are sawed off and a stem is installed into the bone canal previously developed with special tools. The head is put on it, which, in turn, is inserted into a liner placed in the acetabulum. The progress of the operation can be seen in the video below.

Operation

The technique of revision endoprosthetics is very different from the primary installation of an endoprosthesis. One of the reasons for this is the significant loss of bone tissue around the initially installed endoprosthesis. To fix the components of the endoprosthesis, it may be necessary to remove a piece of the patient’s own bone, for example from the pelvic bone, and install it to replace the destroyed bone. When fixing the primary endoprosthesis with cement, before installing a new artificial joint, the remaining cement in the femoral canal and acetabular cavity must be removed. After preparing the bony surfaces of the glenoid cavity and femoral canal, the components of the new endoprosthesis are installed. At the end of the operation, a silicone tube (drainage) is installed to drain the wound contents. The wound is sutured layer by layer, after which an aseptic bandage is applied.

As with all major surgical interventions, complications occur after revision endoprosthetics.

Prognosis and possible complications

The service life of a properly installed, high-quality hip replacement with a lifestyle of moderate physical activity is 20-25 years (according to the FDA).[3]

Complications associated with implant installation may occur during and after the intervention:

Intraoperative complications include fracture of the femoral shaft, fracture of endoprosthetic components, premature polymerization of bone cement, intraoperative blood loss and fat embolism.
In the early period after surgery, complications from anesthesia, contracture, hematomas, vein thrombosis, bedsores, and soft tissue suppuration may occur. Sometimes anemia, pneumonia, urinary retention, neurological pathologies, and acute adrenal insufficiency develop. Dislocation of the head of the endoprosthesis can be observed both in the early and late postoperative period.
In the long term, there is a risk of loosening and instability of the implant components. Osteolysis of the bone around the prosthesis and Stress-shielding syndrome may progress - redistribution of bone mass with areas of hypertrophy or atrophy of bone tissue. Late complications include fracture of the femur, endoprosthesis stem, joint infection, ossification, migration of the implant cup, and separation of the greater trochanter of the femur.

If you consult a surgeon in a timely manner, many complications can be successfully treated.

Conditions for inclusion in the state support program

To receive government support, you need to collect papers proving the need to provide a quota.

Therefore, a citizen needs to have in hand such certificates as:

compulsory health insurance policy (mandatory condition);
documents proving your visit to a doctor, describing previous treatment;
certificates and extracts demonstrating the progress of the disease.

The above papers are compiled by the medical institution that makes the decision on quotas. However, you should control the process of documenting the disease so as not to encounter the elementary carelessness of doctors.

Apply to the hospital for a quota, even if you do not fall into the above categories. The legislator is constantly improving the regulatory framework. Sometimes changes expand the list of beneficiaries.

Quota assignment algorithm

Currently, the decision on state support for a patient is made at the medical institution that provides ongoing care. This means that the citizen should go to the hospital where he is being treated. This institution has created a special commission that examines quotas.

The commission considers the following circumstances:

results of a complete examination;
opinions of orthopedic specialists;
medical history;
X-rays, tests and more.

The decision of the commission is documented in the protocol of the quota decision. This document is handed to the patient. It is the key to receiving free help.

If a person refuses an examination that takes enough time, he will be denied a quota.

Obtaining a quota coupon

The next stage is to contact the government agency. To do this you need to collect the following documents:

Copies:
Compulsory medical insurance policy;
pension insurance certificate;
disability document (if available);
conclusions about the need for surgical intervention from the clinic (and the original too). This paper contains data: on health status;
diagnostics;
about the activities carried out for the purpose of diagnosis.
Originals:
quota decision protocol;
written statement.

All of the above papers should be taken to the health department. It is advisable to ask the clinic at what level this issue is being resolved today.

The patient’s authorized representative has the right to contact the government agency with an application.

Deadlines for assigning a quota

The government agency considers the application within ten working days.
After a positive decision is made, a package of documents is sent to the clinic where the manipulation will be performed.
The quota committee of this institution sets the date of hospitalization and informs the health department.
A government agency employee informs the applicant about the decision made.

As a rule, you have to wait a long time for hospitalization: from 3 months to a year (or more).

Rehabilitation after hip replacement

Rehabilitation should be inseparable from surgery. The entire recovery process is divided into three periods:

from the end of the operation to discharge from the hospital – 15-20 days;
up to 2-3 months after the intervention;
up to 1 year after endoprosthetics.

Each of the time periods has its own goals, the implementation of which, at least at first, should be carried out by the patient under the strict guidance of medical personnel. The main objectives of rehabilitation are as follows:

prevention of postoperative complications;
normalization of the condition of the uneven muscular system of the leg;
achieving the maximum possible range of motion in the joint;
general strengthening of the musculoskeletal system;
formation of the correct approach, balance and stability during movement and static loads;
adaptation of the patient to everyday life.

A routine examination by an orthopedist is required at 3, 6 and 12 months after the intervention. If alarming symptoms occur, the patient should immediately contact the doctor who performed the operation.

Question answer

Movement is life! When knees begin to hurt, a person is forced to give up walks, travel, meetings, and going to the theater. Joint disease can be caused by a variety of diseases. How not to start the disease, what to do if the doctor recommended surgery?

Sergey Amzaev, a traumatologist-orthopedist of the highest category, Candidate of Medical Sciences, answered popular questions.

What diseases disable knee joints?

First of all, it is progressive osteoporosis, which leads to a change in the shape of the joint and limited mobility. All this is accompanied by pain. Also, diseases of the knee joint can be provoked by injuries and active sports without proper control. But more often it is an age-related pathology that leads to changes in the joint.

What professions are people at risk?

These are people who do hard physical labor. The second group is those who lead a sedentary lifestyle and, as a result, are overweight.

What symptoms should give rise to contact a specialist?

The first sign is pain. Subsequently, the patient begins to notice that his movements in the joint are limited, the joint increases in volume and becomes deformed. In later stages, the axis of the limbs changes. There is no need to let it get to this point - it is better to contact a specialist. Whether surgery is indicated or not will be decided by a specialist at your place of residence or sent to the appropriate specialized institution where a consultation is held.

When does conservative therapy become ineffective and surgical intervention is indicated?

As a rule, when the first symptoms appear, the patient consults a doctor. Treatment begins with conservative therapy: injections, pills, physical procedures. After a course of drug treatment, improvement most often occurs. If there is no positive dynamics, there are anatomical changes in the knee joint, then this is a direct indication for surgery. After all, as a result of the disease, the quality of life decreases, a person cannot perform the physical activities to which he is accustomed, he limits himself to walks, communicating with relatives, going out into nature, and playing sports. All this is accompanied by pain, so the person is forced to walk less.

What is endoprosthetics?

This is the replacement of a joint with an artificial one, both knee and hip. An implant, that is, a prosthesis, is placed. Why is this being done? When conservative therapy does not help and there is an indication for joint replacement, surgery allows you to restore range of motion and eliminate pain. After surgery and a full course of rehabilitation, the patient returns to a full lifestyle. A person does not feel the difference: he had a healthy joint or now he has a prosthesis.

What types of knee replacements are there?

There are a lot of types. These are mainly foreign manufacturers. Domestic analogues, unfortunately, are inferior in reliability to imported ones. All endoprostheses differ in materials, method of fixation, and installation method. The doctor conveys this information to the patient at the stage of planning the operation.

What are the contraindications? Can a doctor refuse to perform an operation? How to prevent this?

Contraindications are concomitant somatic pathologies and chronic diseases. Basically, these are cardiovascular diseases, diseases of the digestive tract, pathology of veins and arteries. If the patient pays attention to his health and is determined to undergo surgery, then it is enough to undergo a short course of preoperative preparation and all contraindications will be removed. An absolute contraindication is being overweight. Body mass index is calculated, and a figure greater than 40 is an absolute contraindication. In this case, the operation will not bring relief to the patient. All other pathologies are treated, corrected, and the patient is taken for surgery. But being overweight is not a death sentence. The doctor may recommend contacting an endocrinologist or nutritionist. If a person is determined to undergo surgery and return to a full life, then he pulls himself together and loses weight.

Can advanced age be a contraindication for endoprosthetics?

It is a myth. Our oldest patient was 91 years old. At the same time, his state of health was relatively satisfactory; somatically he was practically healthy. There were also those who, at the age of 43-45, had many concomitant chronic diseases and before undergoing surgery, they had to take up to six months to take care of their health. In a word, age is not a contraindication for endoprosthetics.

How is the operation performed and how long does it last? What anesthesia is used?

Compared to the last decade, medicine has come a long way. Thanks to the introduction of modern high-tech approaches and techniques, this operation lasts from 40 to 60 minutes. Various types of anesthesia are used. Before the operation, the patient is carefully examined, doctors eliminate all risks and only after that they take him to the operating table. In 80% of cases, gentle spinal anesthesia is used when the lower part of the body loses sensitivity. A person hears everything, you can talk to him. To prevent the patient from feeling anxiety and fear, special medications are used - relaxants.

How many days does a person stay in hospital?

The first stage of rehabilitation after surgery lasts 5-7 days. If a more in-depth, enhanced recovery is needed, the patient will stay for another 10 days. The maximum period is 21 days.

On what day can the patient get out of bed?

Two hours after the operation, the physical therapy doctor lifts the patient, gives him crutches and asks him to take a few steps around the bed. This occurs in the intensive care unit in order to avoid thrombosis of the lower veins. Then he is transferred to the department, where on the very first day the doctors get him back on his feet.

Who is indicated for longer rehabilitation? How is it different from the usual one?

The first stage of rehabilitation is aimed at recovery after the surgical intervention itself. This is the postoperative period. The second stage is indicated for patients in the older age group, when a person has remained motionless for a long time and has lost his walking algorithm. Roughly speaking, he is being taught to walk again. Another group is patients with increased expectations of effect after surgery. These are active people who would like to quickly return to their professional activities or active sports. It is important for them to recover as efficiently and quickly as possible. Of course, we do not recommend that patients engage in extreme sports immediately after surgery, but if there is a strong desire, then this is available after the second stage of rehabilitation. There are no contraindications if the load is reasonable and under the supervision of a specialist.

How is rehabilitation after surgery in hospital mode?

There is a special device called Artromot. It automatically develops the knee or hip joint. At the same time, the exercise therapy doctor sets the frequency of flexion, efficiency, and all this is controlled using a chip card for each patient. Modern methods of physiotherapy are also used. For example, cryotherapy, when the surgical area is numbed with cold air, muscle tension is relieved and the person can recover effectively. If we are talking about weakened patients, there is a special suspension system, when they are placed in a kind of hammock, and under them there is a special treadmill, in front of them there is a mirror. This is how the skill of movement, walking, how to place the foot, and at what angle is restored.

Are there any restrictions in physical activity after completion of rehabilitation?

There are no restrictions if the patient recovers fully. Here I remember an anecdote when a patient asks a doctor before surgery on his hand: “Doctor, can I play the piano?” He reassures: “Well, of course, you can play.” Patient: “What a good operation, but I couldn’t do it before...” If a person did not play sports before the operation, then after the operation he does not become fit. The person returns to the level of motor activity that he had before the disease.

How often should you see a doctor after successful surgery?

You should take control photographs at least once a year. This is necessary to assess the mineral density of the tissue and the position of the implant. The doctor can correct the manifestations of osteoporosis with medications.

What is the service life of the endoprosthesis?

About 15-18 years, if there are no problems with bone density.

Paid or free? How long should I wait for the operation?

If we are talking about knee joint replacement, then this operation is performed free of charge under the compulsory medical insurance policy for residents of the Sverdlovsk region. We are talking about a government program. The operation is carried out 1-2 months after submitting the application. Rehabilitation is also provided free of charge according to a quota.

How critical is the delay in the operation?

Unfortunately, the tendency is that people walk through pain. They come to a specialist in an advanced state, when changes occur not only in the knee, but also in the joints surrounding it, problems with the spine begin, and muscle atrophy is pronounced. This complicates the doctor’s work, and the patient does not receive the desired effect from the operation. If there are indications for surgery, it is better to do it immediately and not delay. This way you have a better chance of returning to a full, fulfilling life.

Hip replacement surgery in Moscow

Operations to install artificial implants of large joints have been launched not only in the capital, but also in regional centers throughout the country. However, performing hip replacement in Moscow suggests the possibility of choice. The large number of institutions performing this intervention increases the likelihood of finding an ideal specialist and clinic.

In government institutions, the operation is carried out by the country's leading specialists with academic degrees and many years of practical experience. In this case, the patient pays for his own peace of mind.

What indications to use

Indications for joint replacement are the following diseases and pathological conditions:

deforming arthrosis of various etiologies;
comminuted fractures of the head of the bone;
rheumatoid polyarthritis;
Bekhterev's disease;
complex, long-term non-healing and non-union fractures;
autoimmune and tumor lesions of the limb;
aseptic necrosis;
cyst-like reconstruction of the femoral head;
severe injuries of the knee joint and sub-traumatic complications.

Do not delay your visit to an orthopedic traumatologist if:

It’s hard for you to perform your usual movements (bend over, climb stairs, etc.);
constant pain in the joint does not allow one to live normally, and the pain syndrome does not disappear even under the influence of potent medications;
conservative treatment is ineffective;
the disease is at a stage of development where it can only be treated surgically.

There is no need to be afraid of surgery - endoprosthetics has long been a standard practice in the field of surgical orthopedics, and patient reviews confirm the minimal risk of complications and a return to a full life without joint pain. In the surgical center of the GMS clinic, such operations are performed by doctors who are thoroughly proficient in classical and modern techniques of orthopedic surgery.

Hip replacement price

The cost of a hip joint endoprosthesis starts from 75,000 rubles. for a unipolar prosthesis. An implant for total endoprosthetics costs 120,000-200,000 rubles. To estimate the total cost of treatment, you should take into account the cost of surgery, hospital stay and rehabilitation.

In budgetary institutions in Moscow, primary hip replacement has a lower price than in private clinics. It is in the range of 40,000-105,000 rubles. In the leading state center of St. Petersburg, this operation will cost 37,000 rubles. Revision installation of an implant costs on average 1.5 times more.

Clinical example No. 5

Patient Zh, 28 years old. I contacted K+31 in October 2021. I suffered from congenital subluxation of the head of the right femur; no treatment was carried out in childhood (at that time there was no routine ultrasound screening in the USSR, and not all children were referred to a pediatric orthopedist). At the age of 23 years, she noted the appearance of pain in the area of the right hip joint. Over the past 3 years, she has noted an increase in pain, gait disturbance, limited range of motion and gradual shortening of the limb. I contacted K+31, and X-rays were taken, which visualized stage 3 coxarthrosis on the right against the background of dysplasia of the right hip joint.

A decision was made to perform total arthroplasty of the right hip joint with a cementless fixation prosthesis of a ceramic-to-ceramic friction pair, with restoration of limb length.

Pictures after surgery. The length of the limb has been restored. In comparison with the photographs before the operation, it is clearly visible how the normal position of the pelvic ring and lumbar spine has been restored. The patient was operated on on the day of admission, transferred from the RAO 2 hours after surgery, and activated 6 hours after surgery. On the second day she was taught to walk with additional support on crutches.

Where to get hip replacement in Moscow

Extensive experience in hip replacement in Moscow has been accumulated in the following medical institutions:

Central Research Institute of Traumatology and Orthopedics named after. N.N. Priorova;
Central Clinical Hospital of the Russian Academy of Sciences;
City Clinical Hospital named after S.P. Botkin;
Road Clinical Hospital named after. N.A. Semashko;
City Clinical Hospital No. 67 named after L.A. Vorokhobova.

Endoprosthetics are also carried out in other medical centers of the city, including a number of private clinics that provide the service.

Stages of obtaining a quota and necessary documents

To receive preferential care, Russian citizens must see a doctor at the medical institution where the treatment was carried out. This could be an orthopedic traumatologist or a surgeon. Next, you need to undergo a full medical examination, which confirms the presence of pathology of the joint. Based on the results of diagnostics, tests and medical history, the clinic’s quota commission draws up a protocol. If the patient refuses to undergo a long-term examination, he will not be able to receive the necessary benefits.

Having received the protocol of the committee’s decision, the patient needs to prepare a package of documents and their copies:

passport;
compulsory medical insurance policy;
insurance number of an individual personal account;
referral from a surgeon or orthopedist;
pensioner's ID;
papers confirming the assigned disability group;
the decision of a medical institution on the need for an operation, including a description of the patient’s health status, diagnosis, course of treatment and all diagnostic measures;
written statement from the patient.

Having collected the necessary papers, the patient himself or his representative must go to the health department. There, the application received will be considered with the participation of relevant specialists. If necessary, the commission may require the patient’s personal presence to ask him additional questions.

The application is considered by the quota committee within 10 working days. If the patient’s candidacy for the benefit is approved, his documents will be collected and sent to the medical institution, where the endoprosthetics operation will subsequently be performed. The clinic commission, in turn, will again review the documents provided and report the exact date of the patient’s hospitalization.

It is impossible to predict how long the wait in line for the operation will take. This, first of all, depends on the locality and the popularity of the clinic. In big cities, the wait often drags on for several months.

Quota hip replacement

Quota hip replacement, in most cases, involves the installation of an implant with a metal-polyethylene friction pair. It is also possible that the state pays for the work of specialists, and the patient purchases the artificial joint independently. The easiest place to get hip replacements done using budget funds is in Moscow—the largest number of quotas are allocated to this region. If the patient’s clinical case fits the list of indications listed in the relevant legal document, with a competent approach to the issue, passing the commission and getting on the waiting list will not be difficult. However, it should be understood that time is not always of the essence - the earlier the operation is performed, the better the prognosis for restoring joint function.

Who is entitled to quotas in 2021

Until 2015, budget assistance was provided to the majority of applicants who met the established criteria. And this applied to almost all citizens of the Russian Federation. Now it has become much more difficult to get a quota.

The state has reserved only one obligation - to provide free of charge, within the framework of compulsory insurance, only prosthetic services. The prosthesis, the cost of which is quite high, without a quota will have to be paid for from your own funds.

However, there are options for getting full service on a budget. These, according to Decree of the Government of the Russian Federation No. 1273 of November 28, 2014, include the following cases:

postoperative deforming arthrosis;
joint dysplasia due to arthrosis.

Other circumstances under which citizens are granted a quota cannot be excluded.

If a patient who previously (before January 1, 2015) had a joint replaced experiences complications due to a medical error, then the repeated manipulation is carried out at the expense of the budget. Download to view and print

Decree of the Government of the Russian Federation No. 1273 of November 28, 2014

About the individual rehabilitation program

Often patients are not satisfied with the length of the waiting period.

There is another legal method to obtain government support for prosthetics. But to implement it, a serious amount of money is needed.

The essence of an individual rehabilitation program

The point of the event is that the citizen pays the clinic for the costs of manipulation and treatment from his own savings.
After completing all the necessary activities, the money spent is paid to him by the budget.

The benefits in this case are received by all parties to the process, they are as follows:

There is no need to wait for the government agency to pay for the purchase of a prosthesis.
The clinic has the necessary funds to purchase all materials and medicines.
Prostheses are purchased only from the most trusted suppliers and are of high quality.
The budget pays only for the assistance provided, so to speak, based on the actual services performed.

There is only one drawback of the program: a significant amount is required, which will be returned to the citizen after a certain time. The cost of a hip joint prosthesis varies from 120 to 190 thousand rubles. It depends on the design and material of manufacture.

Charitable organizations can finance the purchase of a hip replacement.

Payment for a prosthesis from the budget is made in the following cases:

if the person is disabled due to the disease in question;
the right to receive a prosthesis was documented before 01/01/2015.
others (individually).

Citizens who received the right to a quota before 01/01/2015 are allocated a fixed amount. It amounts to 160 thousand rubles. Additional expenses must be paid from your own funds.

Dear readers!

We describe typical ways to resolve legal issues, but each case is unique and requires individual legal assistance.

To quickly resolve your problem, we recommend contacting qualified lawyers on our website.

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

hours:
mixed (hybrid) - the cup is attached without bone cement, and the stem is attached with cement.