Hip replacement. How passes rehabilitation after surgery in the elderly, the young, whether the disability is put, reviews

If the damage of the head and neck of the femur are replaced hip. human tissue is removed and in their place put the metal implants. Insulating material between the acetabular cup and the femoral head is a polyethylene liner.

In some cases, conduct joint replacement

Hip replacement is performed, if due to an injury or an illness, he collapses and is not subjected to the treatment of conservative therapy.

The following indications for surgery:

• femoral neck and the femoral head;
• restriction of hip joint mobility (TBS) as a result of the injury;
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• purulent abscess soft tissue necrosis of cells of hyaline cartilage;
• the final stage of coxarthrosis development;
• malignancies in cartilage or bone structure of the femur.

Elderly often prescribed operation at the turn of the femoral neck or coxarthrosis. Young people are the indications for surgery or sports injuries malignant degeneration of cells. After surgery the man restores motor activity on the part of the affected joints of the lower limb, get rid of acute pain.

Types replacing TBA

There are several schemes by which the operation is carried out:

• surface replacement;
• total joint replacement;
• bipolar technique;
• monopolar technology.

Procedure type is selected depending on the severity of the pathological process, and general condition of the patient.

total views

Used in 75% of cases, when the femoral neck is broken, there is necrosis or malignant degeneration of cells. During the surgery removed all of the affected joint and replace damaged tissue prosthesis.

After the total hip replacement is almost does not develop side effects, the resulting outcome of treatment is guaranteed retained for 10 years. To carry out the procedure allowed for people under the age of 80 years.

surface replacement

In this situation, the femoral head is not cut away. The surgeon removes only the damaged cartilage surface. Typically, the surface operation performed after injury or under pathological processes affecting only cartilage.

The technique involves coating the femoral head special cap of titanium, which is not rejected by the immune system. Metal ensures smooth sliding of the head in the acetabulum, reduces friction cartilage and ligaments during the motion.

Surface replacement is safer compared to total replacement, it does not imply a complete excision of tissue, so the body needs less time to recover.

Single pole view

Surgery is indicated for people who need replacement of the femoral head. The endoprosthesis is located in the acetabulum is fixed to the cartilage tissue. This type of operation is performed only for older people with physical inactivity. At high physical activity implant creates friction, which is why there is a destruction of hyaline cartilage and raises a number of complications.

bipolar technology

Used bipolar implant having a head with a double knot movements. This form of the endoprosthesis reduces the load on the hyaline cartilage, allowing people to lead an active life after full recovery from the operation.

Progress in joint replacement TBS

Hip replacement is performed individually for each patient, but surgery necessarily involves the following steps:

Stage	Title	Description
1.	Preoperative preparation.	Skin in the procedure disinfected with an alcohol solution of iodine, making the patient under general anesthesia.
2.	Excision of soft tissue.	The surgeon performs layered skin incisions, fat, muscle layer. With a scalpel specialist excised tissue intertrochanteric line, which allows him to get to the joint. The junction is exposed, so that could be cut to make the femoral head when needed or put on her metal cap by removing the damaged tissue.
3.	Formation of the channel.	In the neck the head is separated from the remainder of the femur, the saw cut is performed at an angle. The bone structure by surgical reamer resembling a removable drill tip, the cavity is formed.
4.	Installing the implant of the femoral head.	When the channel is ready, it is inserted into the tapered stem of the implant, which firmly fixes the ball-shaped prosthesis on the bone.
5.	Surgical replacement of the acetabulum.	Scrape and remove scalpel allow hyaline cartilage to insert a metal bowl. It will replace the bone structure of the pelvic bone. The resulting capacity put a plastic implant, which performs the function of cartilage tissue and prevents bone friction.
6.	hip reduction.	After installing the cup it is inserted endoprosthesis femoral head, followed by layering suturing the ligaments and soft tissues. In the post-operative incision placed drainage.

These steps do not change under any form arthroplasty TBS. Surgery is carried out for 3 hours.

Possible complications after surgery

According Biostatistics for 2015 postoperative complications occur in 2% of patients.

Perhaps the development of these types of negative consequences, depending on the time of occurrence:

• Arise in the course of surgery. When excising tissue the surgeon can touch the artery, because of which bleeding begins. If there is a genetic predisposition to the development of allergies there is a negative reaction to latex immunity, drugs for general anesthesia. Perhaps the development of cardiac and respiratory failure in the presence of chronic pathologies.
• early complicationsThat appear within a month after surgery. Improper care of joints can lead to wound infection, zagnoeniyu, abscess or divergence of seams. Violation of vascular integrity, close to the cut surface provokes the development of bleeding. In the postoperative period may implant rejection, the first symptoms: acute prolonged pain, deterioration of tissue regeneration, inflammation of the feet.
• late effects. Loosening of the implant during total hip replacement, joint sprains, atrophy of skeletal muscle around the affected area. In case of failure of the prosthesis there is limitation of the lower limb mobility.

Trigger the development of complications can be poor quality of implants, medical negligence in the selection and installation of the prosthesis, ignoring the recommendations of the rehabilitation period.

Medical and social expertise disability

Disability during arthroplasty given only after passing the examination.

A person is considered legally incapable in the following cases:

• unsuccessful installation of the implant;
• constant feeling of acute pain;
• limited mobility after replacing the TBS;
• inability to care for themselves because of injuries.

For the recognition of disability is going to a council of disinterested experts. Direction to carry out medical and social examination gives the physician in the clinic.

X-ray

Replacing a joint can lead to restriction of the lower limb mobility. The severity of the pathological process is determined by the scale Kosinskaya requiring the passage of X-ray examination.

The following types of mobility disorders:

• Lungs. Limited foot traffic is insignificant, the joint space is narrowed.
• Average. Joint space narrowing greatly during hip motion is heard crunching. Perhaps the development of muscle atrophy due to low activity of the hip joint.
• Heavy. Implant warped or improperly installed, due to which the patient feels strong pain. The finiteness of the inflamed muscles completely atrophied.

The Commission of Experts considers assessment scale Kosinskaya before the verdict.

Functional diagnostics

Doctors check how the amplitude is reduced during the movement of the lower limb:

• Free mobility decreases to 30 °.
• The amplitude drops to 50 °.
• Man moves on foot only 15 °.
• Lower extremity and hip joint are deformed, the foot does not move and keeps one forced position.

Functional diagnostics reaffirms and supplements the data obtained after radiographic examination.

Establishing the degree of function statodynamic

After the external physical examination, diagnostic and functional removal of X-rays determined by the degree of severity of complications:

• Lungs. Leg and implant hurt after long walking, but the discomfort and pain go away after a short rest.
• Average. During the movement of people limping. Hip with the operated side is reduced in volume as compared with a healthy leg.
• Moderately expressed. Affected limb looks shorter person feels constant pain that is exacerbated during movement.
• Heavy. The patient loses the ability of independent travel, constantly feels strong nagging pain.

Determining the degree of statodynamic function is the latest procedure, which must go through a man to complete medical and social expertise. Conclusion The Commission issues after the decision.

The base for disability

hip replacement is an indication to assign disability to the patient only in the identification of functional disorders on the part of the affected limb.

In the absence of movement disorders and normal activity of the operated area status of a disabled person is not assigned. If the implants are installed on both legs, the patient will automatically issue a certificate of II degree disability.

Get detailed information about how to obtain the documents confirming the disability, the patient can learn at the health center. Help is given to people who lose the opportunity to take care of themselves on their own or can not work because of the derived complications during or after surgery.

To execute documents on disability need not only to get directions, but also to be examined by the following experts:

• ophthalmologist;
• orthopedist;
• otolaryngologist;
• therapist;
• neurologist;
• surgeon.

In the presence of any chronic disease will require additional examination by other specialists. For example, in the presence of duodenal ulcers should consult a gastroenterologist. Also conducted medical and social examination, to confirm or deny the incapacity of the patient.

In addition to medical consultations, issued direction to the passage of laboratory and instrumental tests:

• Clinical blood and urine analysis;
• fluorography;
• electrocardiogram;
• articular cavity ultrasound examination;
• X-rays;
• CT and magnetic resonance imaging as needed.

After receiving the results of analyzes and breakdowns of instrumental examinations, a person must collect the required list of documents:

• write a statement on the passage of medical and social examination and get in line;
• make a copy SNILS;
• receive a certificate which proves surgical intervention for replacing TBA;
• make a copy of your passport;
• receive a certificate confirming the absence of a job, or receive the document on the incapacity of the authorities;
• form with the results of the survey.

All documents sent to the Commission, which shall fix the date of the examination and tells her who asks. This procedure allows to evaluate the overall condition of the patient and the possibility of obtaining their certificate of disability. The man must bring a passport.

In carrying out medical and social expertise to assess the level of violations and labor activity of the patient. In the presence of mild functional disorders of the Commission may refuse to obtain the status of a disabled person, if the patient's work does not involve heavy physical load on the legs.

These professions include:

• any job in the office: Call operator, manager, accountant;
• workers control technical equipment in industrial production;
• drivers of all categories.

These activities are an easy labor, which does not create a strong physical stress on the affected joint. If the disability was denied, but the person feels incapacitated, he may appeal the decision of the medical commission.

To do this, the patient will need to send a request to collect the documents and the results of surveys in the Federal Bureau of Medical and Social Expertise. Applications will be reviewed within 30 days, after which the appointed time of re-examination.

If the postoperative effects interfere with self-care, work, or a full life, give the patient II or III group of disability for 12 months. When no improvement in general condition, a certificate renewed for 1 year after year.

Group I shall be issued only in detecting severe disturbances that appeared after the surgery. Usually such people completely lose control of the affected limb.

The third group of disability

Assigned by limiting the mobility of the affected joint to moderate severity. Typically, such complications occur with little deformation of hyaline cartilage or the endoprosthesis. Part III of the group are temporarily for 1-2 years to identify the patient's general condition improvements.

The second and the first group of

I and II disability group assigned to the presence of acute pain and severe limitation of mobility of the affected limb.

The Commission in the decision is based on the severity of the symptoms:

• I degree of disability shall be issued in the absence of hip mobility, when a person is unable to move independently and in need of care;
• Group II is assigned when a strong restriction of mobility, there is a sharp pain when a person is having trouble moving.

rehabilitation measures

A hip joint replacement in the absence of proper rehabilitation can lead to the development of these complications 1 year after:

• Dislocations, subluxations. Lead to a loss of the acetabular prosthesis. The pathology occurs when heavy physical work, wrong selection of the implant.
• Venous thrombosis of the lower extremity. Blood clots often occur in people who neglect to exercise after surgery. The inactivity under the blood moves more slowly through the vessels, there stagnation. Platelets adhered to each other and close the vein lumen.
• Neuropathy. If during the operation were pinched or damaged nerve endings disrupted muscle, muscle atrophy begins.
• Infection of the implant. Pathogenic microorganisms from chronic inflammation foci penetrate the tissue surrounding the hip joint. Bacteria enter the operated area through the blood system from any part of the body: organs of the urinary and reproductive system, the teeth, the maxillary sinus.
• Periprosthetic fracture. In the formation of the channel and installation of the wedge leg bone strength is reduced, there is a risk of fracture.
• Rejection of the implant. The immune system perceives the denture as a foreign body, tissues become inflamed, they start to hurt. red spots appear on the skin. Rejection is typical in situations where a person is implanted prosthesis made of low-quality materials.

With the development of postoperative complications for people assigned to temporary disability and symptomatic treatment.

To prevent negative consequences, rehabilitation activities are carried out:

• On the first day after the operation is necessary to reduce the risk of atrophy of muscle tissue, improve endurance healthy leg. The affected limb is pulled, do isometric exercises - contract the muscles without moving. Under the knee it is forbidden to enclose a cushion to avoid the development of contractures TBS and knee.
• 4-8 days after surgery appoint motor load, provided that the patient can stand on the affected limb. To do this, he is asked to translate all of the weight on the operated leg and stood for a moment, without losing balance.
• On day 11 lifts carry up the stairs. Patients are taught exercises to strengthen the quadriceps muscles and body: jumping, bending, pushing objects, long walks. It is forbidden to cross the legs while sitting on a chair.

To instruct patients on self-care in daily life. People need to learn to keep the thigh steady, sit on a high chair and use items with long handles.

Operation hip replacement may be complete or surface. Type of operation determined by the physician depending on the degree of destruction TBS. During surgery and after installation of the implant 2% of patients begin complications.

Negative consequences arise neglecting medical recommendations for rehabilitation or wrong selection of the implant. If complications cause difficulties in movement or lead to complete loss of motor activity of the thigh, the patient is issued a certificate of disability.

Registration of the article: Vladimir the Great

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