The hip joint is the largest joint in the human body, without which it is difficult to imagine such familiar actions as walking, squatting, running, and maintaining an upright body position. Experiencing enormous stress, it is very susceptible to various kinds of pathological changes, which bring not only pain, but also disruption of its function. In such cases , replacing the hip joint with an artificial endoprosthesis becomes the only way to return the patient to his former activity and normal lifestyle.
The hip joint connects the legs to the pelvis. The articulation involves the head of the femur, immersed in the acetabulum of the bony base of the pelvis. To ensure movement, the articular surfaces are covered with cartilage tissue, and the joint itself is surrounded by a good muscular frame and strong ligamentous apparatus.
A healthy hip joint is involved in tilting and turning the body, bending and rotating the legs, and ensures correct gait and posture. We don’t think twice about performing these actions, but any change in the joint leads to severe discomfort and loss of usual functions. Both excessive loads and lack of movement can contribute to changes in joint elements; various types of injuries, inflammatory processes, and infections can lead to irreversible consequences when surgery is required.
Indications for hip replacement are:
Arthrosis is the most common reason for surgery. In case of damage to the hip joint, they speak of coxarthrosis. This condition represents changes of a degenerative-destructive nature, in which cartilage is destroyed, bone surfaces are deprived of their protective layer and are deformed. The discrepancy between the load and the capabilities of the affected joint leads to worsening changes, pain and limited mobility. Cartilage tissue is not able to recover, and the process is irreversible. Osteoarthritis is promoted by chronic injuries and malnutrition of the joint.
Wear and tear of the hip joint occurs in old age due to overload with movement, body weight, and heavy lifting. Over time, the nutrition of the joint elements is disrupted, the cartilage becomes more fragile and brittle, and the joint ceases to play the role of a shock absorber. In such cases they talk about “age-related wear.”
Trauma is also a common cause of hip dysfunction. Injuries in this area often result in a fracture of the femoral neck, which is considered a common pathology of the musculoskeletal system in older people. Elderly women, who suffer from osteoporosis and brittle bones due to age-related hormonal changes, are especially susceptible to hip fractures.
Already existing in old age, secondary changes in articular elements, impaired nutrition of cartilage and bone tissue lead to the fact that the fusion of bone fragments is almost impossible. Patients are forced to lie down, and walking is out of the question. Such bed rest is in many ways more dangerous than the fracture itself, since it contributes to the exacerbation of chronic pathology of the lungs, heart and blood vessels. Bedridden patients after a hip fracture have an increased risk of stroke, thromboembolic complications, bedsores, and pneumonia are likely, so they need hip replacement surgery. It allows not only to avoid serious complications, but also to save the patient’s life.
In the case of other injuries, accompanied by damage to the ligamentous apparatus, cartilage tears, dislocations, post-traumatic coxarthrosis , due to which there is a need for surgical treatment.
If the formation of a joint is disrupted in the prenatal period or early childhood ( dysplasia, congenital dislocation ), trophic disorders and degeneration of the osteochondral base are inevitable. Early arthrosis develops, pain appears, and movements become difficult.
Inflammatory processes can be caused by rheumatoid arthritis, gout, systemic connective tissue diseases, and injuries. All of them lead to destruction of articular elements and the need to replace them with artificial ones.
Other reasons why endoprosthesis replacement is necessary include aseptic necrosis of the femoral head due to closure of the feeding arteries, excessive load on the joint due to obesity, trophic disorders due to diabetes mellitus and other metabolic diseases.
The listed conditions cause irreversible damage to the joint, so the solution to preserve the ability to move is surgery to replace it. You shouldn't be afraid of her. Of course, the intervention is not simple; it will require certain efforts from the patient both in preparation and at the rehabilitation stage, but this is the only opportunity to eliminate pain and return to previous motor activity.
When it is clear that surgery cannot be avoided, it is important for the doctor to assess the possible risks and contraindications to the intervention, because most patients are elderly people with a “whole bunch” of concomitant diseases.
So, can be considered contraindications to hip replacement:
Acute arthritis of the hip joint can prevent normal implant healing and is dangerous due to the generalization of inflammation, so it should be treated conservatively.
If the patient suddenly falls ill with an infectious pathology during the period of the planned intervention (ARVI, pneumonia, intestinal infection, etc.), then the operation will have to be postponed until complete recovery.
Chronic foci of inflammation, even sluggish and sometimes unnoticeable, like a carious tooth or an abscess on the skin, must be eliminated. Surgery is a serious stress that can lead to the spread of infection throughout the body.
If the patient suffers from severe diseases of the internal organs in the stage of decompensation, then surgery is contraindicated for him. In such cases, if possible, the condition is brought to a stable state. For example, they adjust the insulin dose for a diabetic, select effective antihypertensive drugs for a hypotensive patient, restore the heart rhythm in case of arrhythmias, etc. If doctors manage to compensate for the pathology, then the operation may become feasible.
Young patients are a special group of patients. Usually the question of endoprosthetics arises in the event of injuries. If in the case of old age the indications are completely definite, then for young people the operation will be prescribed only if all possibilities for restoring their own damaged articulation using organ-preserving techniques have been exhausted.
Proper preparation for surgery is an important component of the entire treatment, which also determines the final result. It is important to conduct a maximum study of the function of vital organs, prevent exacerbation of chronic diseases, normalize weight and activate muscles.
Preparing for a hip replacement should begin several weeks before your planned surgery. It includes:
All of the above studies can be done in the clinic where the operation is planned, but it is more advisable to carry them out on an outpatient basis in your clinic and come to the doctor with ready-made results, on the basis of which the method of anesthesia will be chosen.
An important point in preparation is obtaining permission for the operation from the therapist. Many patients, especially the elderly, suffer from chronic pathology, which may worsen or serve as a contraindication to intervention. Before endoprosthetics, blood pressure is adjusted to consistently normal values, blood sugar levels in diabetics, and weight loss in case of obesity is desirable. If caries is present, it should be treated by a dentist, since it is a source of chronic infection.
During the recovery stage, muscle condition plays an important role, so it is advisable to start training at the preparatory stage. A doctor or exercise therapy instructor will help you learn exercises to strengthen the muscles of your arms, torso, and legs.
Patients who have undergone prosthetics will need to use crutches or a walker to move around, so you can try using them in advance.
Smokers should, if possible, give up the bad habit if they do not want to face complications from the lungs and prolonged wound healing.
If you are taking blood thinning medications, you should notify your surgeon and stop taking them at least a week before surgery. By the way, some aspirin-based drugs may not be canceled (thrombo-ass, for example), but only a doctor should give such a recommendation.
When all the necessary procedures have been completed and permission for the operation has been received, the patient is sent to the clinic, placed in a ward, the anesthesiologist talks with him about the preferred method of pain relief, and the surgeon plans the course of the upcoming intervention. The patient fills out a questionnaire and consents to the operation after a conversation with a doctor, who informs about possible complications and risks.
On the eve of the operation, eating is prohibited from seven o'clock in the evening, and from midnight - both food and water. This condition is very important to ensure safe anesthesia and prevent dangerous side effects (vomiting, for example). You should take a shower and put on clean clothes, try to get enough sleep and not worry, relying on the experience and knowledge of the staff.
Immediately before the operation, the healthy leg is bandaged with an elastic bandage to prevent thrombosis, and a catheter is inserted into the bladder, which will be removed the next day after endoprosthetics.
As a hip joint endoprosthesis, various structures are used, consisting of inert materials (metal, ceramics, polymers) that are strong enough to perform movements with their help. The endoprosthesis must best match the joint being replaced and is selected individually in size.
A hip implant is a hinge consisting of a rod that is fixed into the femur, an acetabulum that is pressed into the pelvic bone, and a metal or ceramic replica of the femoral head that is embedded in an artificially created acetabulum.
The materials used to make prostheses are inert, do not cause a reaction from surrounding tissues and take root well. Many patients wonder whether it is possible to conduct such a popular study as MRI after endoprosthetics. Titanium alloys and synthetic components of the prosthesis are paramagnetic, do not shift or heat up in a strong magnetic field, therefore such research is not contraindicated after surgery.
Prostheses are fixed to the bones in several ways:
The intervention takes about 2-3 hours, preference is given to minimally invasive approaches that provide the least amount of tissue trauma. Hip replacement is a high-tech procedure that requires highly qualified and experienced surgeons, on which the outcome of the intervention depends.
The patient is placed on his side, the leg is bent and fixed. The operation is carried out in several stages:
The operation can be performed under general anesthesia or epidural anesthesia. With the second option, the patient can sleep if there is such a desire. The choice of anesthesia method is determined by the presence of concomitant pathology and the desire of the patient.
Immediately after the intervention, a control X-ray examination is performed to ensure that the prosthesis is installed correctly, then the patient is sent to the recovery room or intensive care unit. In some cases, the patient may be immediately transferred to the traumatology and orthopedics department.
In the ward after surgery, the limb is covered with pillows or special cushions to prevent unwanted movements. The patient's condition is monitored by the surgeon and nurses who monitor the course of the early postoperative period.
After endoprosthetics, painkillers are prescribed, the wound is regularly examined, drainage is used, and the catheter is removed from the bladder. Antibiotics are indicated to prevent infectious complications. On days 12-14, the stitches are removed and you are allowed to shower.
When the main fears associated with the need for surgery are over, the patient has successfully survived it, it is worth immediately making every effort to rehabilitate after hip replacement.
Recovery needs to start as early as possible. Bed rest does not mean immobility, and the first exercises are performed in bed under the supervision of a doctor, slowly, 5-10 times each:
Exercises performed while standing:
The day after the operation, the patient is usually allowed to stand up and walk using a walker or crutches. During this period, it is important to avoid excessive activity and traumatic movements. It is better to go up and down stairs with outside help.
Patients should be informed that certain types of movements are strictly prohibited :
Home rehabilitation continues after discharge from the hospital (after 1-2 weeks). It includes exercises that the patient has already mastered while in the hospital, as well as new ones - with an elastic band, on an exercise bike. Walking is useful, the duration of which increases gradually, and in the early stages you need to use a cane to prevent falls.
Feedback from patients after endoprosthetics is positive, and in 95% of cases it is possible to achieve a good treatment result. Already in the first few weeks, the pain goes away, and it becomes possible to perform various movements. After one and a half to two months, it is possible to return to usual duties and activities, driving a car, and resuming work.
Possible complications are associated with thromboembolism, bleeding, infectious and inflammatory processes, and injuries after surgery. If you experience pain, redness of the skin, severe swelling of the leg, or fever, you should immediately consult a doctor.
Many patients are concerned about whether they will become disabled after a hip replacement. Since the operation is intended to eliminate the symptoms of arthrosis, pain and restore movement, it cannot be considered a reason for disability, provided that the treatment was effective. Moreover, if before the operation there were some restrictions due to significant impairment of motor and static function, then after successful joint replacement they can be removed.
On the other hand, a dangerous consequence of the operation is postoperative arthrosis, which may be the reason for establishing a disability group. An incorrectly selected prosthesis, inadequate or insufficient rehabilitation can also lead to complications and disability.
The required disability group (I-III) is established based on the degree of impairment of motor function and the severity of coxarthrosis by the conclusion of the ITU, to which the patient is referred after the necessary examinations.
Endoprosthesis replacement surgery can be performed either for a fee or free of charge. In the case of paid treatment, the price is very variable and depends on the materials and design of the prosthesis, the qualifications of the doctor, and the time spent in the hospital. On average, the cost of joint replacement in a public clinic is 45-50 thousand rubles. In private it reaches 300-400,000, in this case, in addition to the prosthesis itself, the patient needs to pay for all studies and consultations with specialists, consumables, as well as every day of treatment in the hospital.
Hip replacement is a case where you can get a quota for treatment. For an operation under a quota, it is necessary to provide the appropriate medical documents to the selected clinic, after which (if there are quotas) a “Quota Decision Protocol” will be issued, on the basis of which the patient is included in the operation plan. After that you need to wait your turn.
Hip replacement can be done in hospitals that have a trauma department. It is not so important whether it is a public or private clinic, because the result depends on the quality of the endoprosthesis and the qualifications of the surgeon. In Moscow, endoprosthetics are performed in City Clinical Hospital No. 1, State VKG named after. Academician N.N. Burdenko and others. Any public hospital with a trauma department can offer such a service, but if there is a desire and financial opportunity, the patient has the right to go to paid clinics both in Russia and abroad.
Any pathology of the hip joint with pain and limited mobility should be a reason to contact a traumatologist and resolve the issue and the need for surgery. Some patients tend to endure the pain and wait, but the changes only progress and there is no improvement. A competent specialist will help you decide on the timing of the operation, select the most suitable type of endoprosthesis and give you the opportunity to live an active life for many years.
Coxarthrosis of the hip joint is a disease that destroys it and is dystrophic in nature. Another name for the disease is arthrosis or osteoarthritis of the hip joint. The following material is devoted to stage 3 pathology. The disease at this stage requires mandatory medical assistance; sometimes surgical intervention is indispensable.
How to cope with coxarthrosis without surgery? Modern medicine offers a lot of options to slow down degenerative processes and restore normal mobility of the hip joint. Carefully study effective methods and choose the appropriate one.
The disease provokes a change in the properties of the joint fluid: it becomes thick, viscous, which is why the cartilage is poorly lubricated and begins to gradually wear off. Over time, deformation of cartilage and bone tissues is observed, which significantly limits the patient’s mobility. The main causes of coxarthrosis include:
Before starting treatment, it is necessary to identify the cause of the pathology and eliminate the negative factor. Coxarthrosis of the 3rd degree is an advanced form of the disease; it is better to prevent degenerative changes to such a state.
Find out more about the beneficial properties and rules for using shark oil for joints.
Read the instructions for using Collagen Ultra gel for joint pathologies on this page.
The third degree of coxarthrosis of the hip joint is accompanied by severe pain, swelling, the patient can hardly walk, the person may be given a 2nd group of disability. It is important to immediately visit a doctor and begin treatment. There are several stages of pathology development:
The third stage of coxarthrosis in most cases requires surgical intervention. With the development of the pharmacological industry and the development of new techniques, it is possible to cope with pathology using conservative methods.
How to treat coxarthrosis of the hip joint? Only regular care for the condition of the hip joint will provide proper support, slow down degenerative processes, and improve motor activity. Follow the doctor's recommendations, listen to how you feel. If no positive changes are observed, consult a doctor, he will prescribe another method of treatment.
Therapeutic exercise shows excellent results; after a month of regular exercise, pain will decrease, swelling will subside, and the range of movements will increase significantly. If you have a grade 3 disease, do not overload the joint, do exercises to the best of your ability. Over time, you will be able to increase the number of repetitions and the duration of the workout.
Therapeutic exercises and gymnastics for coxarthrosis of the hip joint:
Perform therapeutic exercises at least twice a day, each session should last 15 minutes. Only regular therapeutic manipulations will give the desired result and help cope with grade 3 coxarthrosis.
Limitation of mobility significantly reduces the body's protective functions by increasing the breakdown of muscle protein. The patient's diet should be rich in protein foods; such measures will help restore the patient's muscles. Recent studies have confirmed that elevated cholesterol levels have a negative impact on the musculoskeletal system. Eliminate flour and fatty foods from your diet, and try to lose weight.
Dairy products, cereals, herbs, vegetables, fruits, cereals, lean fish and meat are useful for damage to the hip joint. Get carbohydrates from dried fruits, honey, and cereals. Avoid frying; try to boil, steam or eat all foods raw.
It is strictly forbidden to use:
Natural products relieve pain, cope with swelling, and improve the motor activity of the affected joint.
Treatment of coxarthrosis of the hip joint with folk remedies:
You can cope with a disease of the third degree with the help of special therapeutic manipulations:
All procedures are prescribed by a doctor and performed by an experienced specialist. Stem cells are also used; they trigger the regeneration process and have a beneficial effect on the patient’s recovery.
Surgical intervention is indicated only in cases where conservative treatment methods have not given the desired result, the patient continues to experience pain, and the mobility of the affected joint is significantly reduced. Do not allow the disease to progress to another stage, the consequences of which are irreversible.
Learn about first aid and how to treat a sprained ankle.
The beneficial properties and use of alcohol tincture of the Golden Mustache for joints are described in this article.
Follow the link http://vseosustavah.com/bolezni/artroz/lechenye-doma.html and read about treatment options for deforming arthrosis of the knee joint at home.
The development of the disease can be prevented only by identifying the pathology in time and taking the following measures:
In the following video, Dr. Bubnovsky will show exercises for people who have been diagnosed with coxarthrosis of the hip joint and talk about how to perform them correctly:
Did you like the article? Subscribe to site updates via RSS, or follow updates on VKontakte, Odnoklassniki, Facebook, Twitter or Google Plus.
Bilateral coxarthrosis (arthrosis of the hip joint, degree 2) is a fairly common pathology. It occurs when blood circulation is impaired, and, therefore, the flow of nutrients into the cartilage tissue. Subsequently, it undergoes significant changes and then complete destruction. The disease spreads not only to the area of the joint itself, but also to the muscles and bones located next to it, which subsequently also undergo degenerative-dystrophic changes.
Arthrosis is most often diagnosed in people over 50 years of age, and in women 3 times more often than in men. Their pathology usually develops during menopause. There are four stages of disease development. The first is manifested by signs of minor severity; at the second stage, the changes become more significant, the person begins to be bothered by unpleasant sensations; During the subsequent development of the disease, pathological processes are observed that do not allow a person to live a full life. Let's take a closer look at how to treat grade 2 coxarthrosis of the hip joint in order to prevent undesirable consequences.
The hip joint is the largest joint in the human body, which bears a huge load. With its help, the legs move in all directions, which anatomically anticipates the possibility of disruption of its functionality and injury. For the smooth operation of the joint and its healthy condition, the following conditions must be met:
Rheumatologist Pavel Evdokimenko will help you understand the causes of the disease:
If any of these conditions do not correspond to the normal state, irreversible (not amenable to correction) disorders of a dystrophic nature will begin to occur. Most often, grade 2 coxarthrosis of the hip joint occurs due to insufficient blood supply and nutrition of the cartilage tissue, which subsequently becomes thin (dystrophic process). The problem then affects the subchondral bone and osteophytes (bone growths) and cysts (cavities) begin to form. As a result of such processes, anatomical changes occur in the structure of the joint (it becomes deformed), which limits its mobility and causes pain reactions in the body. If you do not start treating the patient in a timely manner, the inflammation will spread to all nearby tissues: muscles, ligaments, blood vessels. Periarthritis will be diagnosed. If there is no need for treatment, in this situation the most serious stage of arthrosis will develop - ankylosis, in which complete dysfunction of the joint occurs due to the fact that it is completely destroyed, the person will become disabled.
If a person is diagnosed with arthrosis of the hip joint of the 2nd degree, then his cartilage tissue becomes loose and covered with cracks.
The reasons causing the development of pathological processes include the following factors.
The intensity of the symptoms of arthrosis is directly related to the degree of its development. The most characteristic signs of coxarthrosis are the following.
These signs can be observed on one leg - in this case, right-sided or left-sided coxarthrosis is diagnosed. If there is bilateral coxarthrosis of the 2nd degree, then the symptoms will appear simultaneously on both legs. In this case, pathological disorders are also observed in the lumbosacral spine.
It is extremely important to remember that often in the first two stages of development of unilateral or bilateral coxarthrosis, a person experiences pain in the knees. This is explained by the fact that due to dysfunction of the hip joint, the load on the knees increases.
Therefore, if pain occurs in any area of the lower extremities, it is necessary to consult a doctor and undergo a comprehensive diagnosis to determine the cause of the discomfort. This will help to start treatment for stage 2 coxarthrosis in a timely manner and avoid unpleasant consequences.
The main method of treating grade 2 arthrosis of the hip joint is the use of drug therapy; in this case, surgery can be avoided. With its help, pain and inflammation are reduced or completely removed, and damaged cartilage tissue is restored.
Arthrosis is usually treated by an orthopedist or rheumatologist. The following types of medications are used.
To stop destructive processes in cartilage tissue, chondroprotectors are used: drugs based on chondroitin and glucosamine.
It has been proven that both types of drugs are effective in the treatment of grade 2 coxarthrosis of the hip joint. These drugs have no side effects and can be used for a long period of time. A more or less noticeable result can be observed no earlier than six months after taking the medication.
Treatment of grade 2 coxarthrosis with chondroprotectors requires strict adherence to the prescribed dosage and regularity of use. Otherwise they will not give any result.
A surgical solution to the problem is used in cases where conservative treatment does not provide sufficient results and the disease progresses. For the treatment of grade 2 coxarthrosis of the hip joint, the following types of operations may be prescribed:
These methods help restore the mobility of the hip joint and remove deformed areas and growths.
Additional methods of treating bilateral coxarthrosis include exercise therapy, massage, and diet.
The use of therapeutic exercises for grade 2 coxarthrosis of the hip joints helps improve blood flow and nutrition to the affected joints, accelerate recovery processes in them, and strengthens muscles and ligaments. The instructor selects a set of exercises so that the patient does not experience static load. In addition to therapeutic exercises, swimming pool exercises and leisurely walks are recommended.
Nutrition for coxarthrosis must be balanced, because One of the conditions for the occurrence of arthrosis is obesity. Normalization of body weight is one of the tasks that must be solved for successful treatment of the disease. You should eat at least 4-5 times a day in small portions. Limit fatty, floury, fried and very spicy foods. Maintain drinking regime.
At home, you can use folk remedies to relieve swelling and pain. As a rule, alcohol compresses and lotions with the addition of honey, aloe, iodine, etc. are used. Before using any such remedy, you should consult a doctor.
Even more folk recipes in our video:
Timely detection of coxarthrosis of the hip joint and an integrated approach to treatment will allow a person to restore its full function and avoid its progression and complications.