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About Treatment

Hip pain is most often the result of osteoarthritis and can seriously affect the ability to lead a full and active life. Osteoarthritis of the hip joint in medicine is called coxarthrosis.

Hip arthroplasty will help you get rid of pain and return to a fulfilling life. Over the past 20 years, thanks to the introduction of new materials and techniques into practice, the results of endoprosthetics have improved significantly.

Hip replacement surgery is becoming more and more common as the world's population ages. Currently, hip replacement surgery is the most frequently performed in the world.

Hip arthroplasty is a total or selective replacement of joint parts that are in direct contact with each other during movement.

Total hip replacement is a complete replacement of the head and neck of the femur and the acetabulum with artificial ones.

The hip joint is spherical in structure, so movements in it are possible in many planes. The joint is formed by the acetabulum, forming a kind of deep bowl and the head of the femur, which is shaped like a ball.

The head of the femur is connected to the main part of the femur by a short piece of bone called the neck of the femur. Strong and thick muscles and tendons surround the joint.

The surfaces of the acetabulum and femoral head are covered with articular cartilage. The thickness of the articular cartilage is about half a centimeter in large joints. Articular cartilage is a hard and smooth material that covers the bones in the joint area. Articular cartilage allows the covered bones to glide smoothly relative to each other without being damaged. The color of the articular cartilage is white and shiny.

The joint is surrounded by a waterproof capsule, inside of which a special fluid is produced that lubricates the articulating surfaces. The bones in the joint hold tight ligaments and muscles together. The design of the hip joint provides extremely high mobility while maintaining satisfactory stability.

The powerful muscles around the joint allow us to move in an upright position for a long time, as well as, if necessary, to accelerate when running and jumping. Also, important nerves and blood vessels run around the joint.

When Endoprosthesis is Needed?

The main indications for endoprosthesis of the hip joint are arthrosis of the hip joint (coxarthrosis), fracture of the femoral neck, and aseptic necrosis of the femoral head.

With arthrosis, degenerative changes occur in the articular cartilage, which ultimately leads to wear and tear of the cartilage. Bone growths (osteophytes) are formed around the joint.

Due to wear and tear of cartilage, decrease in its thickness, a significant decrease in smoothness, as well as a change in the shape of the articular surfaces, friction in the joint increases, which leads to pain and progressive disruption of movement in the joint.

Aseptic necrosis of the femoral head is another cause of destruction of the hip joint. In this disease, the shape of the femoral head changes, the bone tissue that makes up the head is resorbed.

The articular surfaces of the acetabulum and the head of the femur cease to correspond to each other in shape, pain and impaired movement in the joint appear. The causes of the disease can be previous dislocation of the hip, trauma at birth, long-term treatment with corticosteroids, as well as some infections.

The main goal of replacing a joint in any of the degenerative diseases with an artificial one is to reduce pain and return movement. For this, the damaged surfaces are replaced with artificial ones, as a result of which smoothness and painlessness of movements in the joint returns.

Fracture of the femoral neck is also an indication for joint replacement surgery. With fractures of the femoral neck, the blood supply to the head is disrupted, and therefore its gradual destruction occurs.

Fracture healing under these conditions is impossible, surgery is the only way to return patients to daily activities.

Replacement can be total, when both components are replaced, and unipolar. In unipolar endoprosthesis (hemiarthroplasty), only the femoral component changes. Hemiarthroplasty is usually performed for femoral neck fractures in elderly and debilitated patients.

With this type of endoprosthesis, the earliest verticalization of  patient is allowed, already the next day. This significantly reduces the risk of thromboembolic and hypostatic complications in old patients with femoral neck fractures.

 

Quick Details
  • Indications

    Coxarthrosis of various etiology
    Fracture of the neck or head of the femur
    Tumor of the hip joint
    Rheumatoid lesions of the hip joint

  • Duration of Surgery

    1,5 - 2,5 hours

  • Hospitalization

    5 days

  • Rehabilitation Period

    14-21 days

  • Incapacity to Work

    6 weeks

Preparation for Hip Joint Endoprosthesis

The decision about the operation is made by doctor together with patient. After clarifying medical history, doctor performs a thorough clinical examination to measure the current range of movement, the level of pain, and  patient's functionality. During the examination of  patient, surgeon examines data of CT and MRI studies.

You will also need  thorough and complete medical examination before surgery. This is done in order to minimize the risk of complications during the operation. If long-term surgery is expected or patient's hemoglobin level is below normal,  blood transfusion may be required after or during surgery. Prevention of thromboembolic complications is mandatory.

Types of Endoprosthesis

There are several main types of endoprosthesis - cementless and cemented.

Cemented prostheses are held in the bone using a special cement that fixes the metal to the bone. The surface of cementless prostheses is made in such a way that the bone tissue grows into it over time, due to which the prosthesis is held in the bone. In order for the endoprosthesis to grow, the bone is processed with special instruments.

Both types of endoprosthesis fixation are widely used in medical practice. Also, in some cases, a combination can be used, when, for example, the acetabular component (cup) is fixed with cement, and the femoral component (stem) is cementless. Surgeon decides whether to use a cemented or cementless endoprosthesis based on  patient's age, lifestyle and bone quality.

How is the Procedure Performed

Surgeon accesses the hip joint and a skin incision is made in the upper third of the thigh. After the hip is exposed, surgeons dislocate the worn out femoral head from the acetabulum. Next, with the help of special devices, the acetabulum is processed. During the treatment, the worn cartilage is completely removed and a hemisphere is formed into which the acetabular component will be implanted.

After the acetabulum has been formed, surgeon fills the cavity with bone cement and installs a suitable acetabular component. Correct spatial orientation of the acetabular component at the correct angle is important at this stage. This affects the life of the endoprosthesis reducing complications in the postoperative period.

After the cement has set and the acetabular component is fixed, surgeon proceeds to the femur. At this stage, the bone canal of the femoral canal is developed with special rasps to the required size. Next, cement is placed in the prepared canal in the femur and the femoral component is inserted.

The head of the required size is selected and the femoral component is adjusted into the acetabular. Surgeon then checks the hip stability and range of movement. Once surgeon is sure that everything is in place, the wound is sutured in layers. Drainages are being installed for a day. Patient's rehabilitation begins from the first day.

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