Replacement of the knee and hip joints is one of the most frequently conducted orthopedic operations for patients over 50 years old. According to the American registry of joint replacement, more than half a million such operations are performed in the world every year.

In this article, we will figure out to whom it is the replacement of joints indicated, how is the operation performed and details about the postoperative period.

READ IN THE ARTICLE:
Indications for joints replacement
Contraindications to joints endoprosthesis
Preparing for an operation
How is an operation performed to replace the knee and hip joints?
Types of knee and hip implants
Postoperative period
Rehabilitation after joint replacement
Lifestyle after joint replacement
Durability of prostheses and repeated replacements

INDICATIONS FOR JOINTS REPLACEMENT

The main indication for joint replacement is the loss of the ability to move, decrease in flexibility and severe pain during movement. Diseases in which endoprosthetics are indicated

KNEE JOINT:

  • rheumatic or gouty arthritis;
  • arthrosis;
  • severe injury to the joint;
  • bechterew’s disease.

 

HIP JOINT:

  • aseptic necrosis of the head of the femur (osteonecrosis);
  • false joint of the femoral neck;
  • rheumatoid arthritis;
  • bechterew’s disease;
  • fracture of the neck of the thigh.

Joint replacement – in most cases, a planned operation. It can be recommended by the attending physician after a detailed analysis of the patient’s complete medical history.

Contraindications to joint prosthesis

Contraindications in the case of endoprosthetics are relative and absolute. In absolute, the patient is strictly forbidden to do the procedure. With relative contraindications, the operation can be performed. The main condition is that the benefits obtained should exceed possible risks.

ABSOLUTE CONTRAINDICATIONS:

  • infectious processes in the joint region;
  • severe heart disease (heart failure grade 3, arrhythmia, three-beam blockade);
  • the patient’s condition, in which he can not move independently;
  • respiratory insufficiency.

 

RELATIVE CONTRAINDICATIONS:

  • obesity of the third degree;
  • vein thrombosis;
  • diabetes;
  • hormonal osteopathy;
  • oncological diseases;
  • psychiatric disorders.

 

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PREPARATION FOR OPERATION

Preparation takes from 1 to 5 months. Time depends on the patient’s condition and severity of the disease.

The main preparatory stages are:

1. Complete medical examination and treatment of concomitant diseases. It is especially important – to cure the teeth and not to allow irritations or wounds on the skin. This can lead to complications after surgery. Such damage is the source of infection.

 

Knee and Hip Replacement Surgery

2. Strengthening of immunity. The doctor should prescribe the use of immunomodulating drugs. This will help the body recover faster after the procedure.

3. Weight loss. Obesity complicates the process of rehabilitation and increases the load on the joint.

4. Moderate physical activity. To strengthen muscles and ligaments it is necessary even before replacement of a joint. This will prepare the body for future rehabilitation.

5. Laboratory tests and examinations (ECG, fluorography). The procedures will help assess the condition of the body and choose anesthesia dosage.

6. Preoperative diet. Reduces the likelihood of edema. Due to this, the patient will easily undergo anesthesia. 12 hours before the operation, drinking and eating is forbidden.


Doctors recommend in advance to prepare the house, car, room for the patient’s arrival. You need to buy anti-slip mats, install special handles. This will help a person to move more easily and eliminate injuries.
2-3 weeks before surgery, you should practice walking on crutches.

How is the surgery performed to replace the knee and hip joint?

Operations to replace joints are conducted under local (epidural) anesthesia or general anesthesia.

The doctor may prescribe a partial or complete replacement of the joint. In the first case, the surgeon removes the damaged part of the bone and replaces it with an implant. In the second – the joint is removed completely and replaced by an artificial one.

The operation takes 1-2 hours.
Most often, surgeons carry out minimally invasive operations through an 8-centimeter incision. In this case, the postoperative suture heals more quickly and the patient can start rehabilitation after 1-2 days.

TYPES OF KNEE AND HIP IMPLANTS

Implants are classified according to the design and material. They are distinguished by their durability, functionality and price.

TYPES OF THE KNEE IMPLANTS

Prosthetic knee joints are with a motionless (Fixed Bearing) and mobile (Mobile Bearing) platform.


In the first case, the joint has only one mobile component, it is fixed in the femoral part. This type is suitable for people with weak ligaments and tendons. But, in the presence of excess weight, it wears out faster.

Prosthesis Mobile Bearing has two moving parts and simulates the work of this joint. It is indicated to people with healthy muscles and ligaments. The design allows a person to move more actively and naturally.

Parts of the knee endoprosthesis are made of ceramics and polymer.


TYPES OF HIP IMPLANTS

The hip prosthesis consists of a cavity (cup), a ball and a leg for fixation. They are made of different materials.

  • Prosthesis with a metal cup and a plastic ball.
  • Prosthesis with plastic cup and ceramic ball. Deteriorates slower than the prosthesis with a plastic ball.
  • Metal prosthesis. They have a very high strength, but there is a danger that the metal particles will accumulate in the body when the prosthesis is erased.
  • Ceramic prosthesis. They are the most modern and reliable. Their deterioration is slower, about 0.0001 mm per year.

Knee and Hip Replacement Surgery

If the bone damage in the patient is not big, then the surgeon can replace only the surface of the femoral head, without changing the entire joint.

Implants are also distinguished by the type of installation: cemented and cementless.

In the first case, the leg of the prosthesis is fixed in the bone with the help of polymer cement.

The second type of implant is placed close to the bone. Due to its rough surface, the bone tissue with time attach to the prosthesis.

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POST-OPERATIVE PERIOD

After joint replacement surgery, patient stays in the clinic for 5 to 10 days. In the postoperative period, the medical staff removes drains, processes the seams.

On day two, the patient is taught to bend and unbend his leg, sit down and climb. Gradually, with the help of a doctor, a person begins to walk. It is important to constantly rely on crutches until the doctor will not allow them to move independently.

REHABILITATION AFTER JOINT REPLACEMENT

The rehabilitation period lasts from 3 to 5 months. Its task is to completely restore the motor functions. Rehabilitation can take place both in a hospital and at home under the supervision of a doctor.

In the first 6-12 weeks the patient learns to walk alone, sit on a chair. After this, the physiotherapist start to put load on the new joint. A person performs a set of special procedures. Their intensity is gradually increased.

After 6 weeks, the functions of the joints are fully restored. Physiotherapists recommend strengthening the leg muscles so that the prosthesis lasts longer. For this, people practice Scandinavian walking, running, swimming, riding a bicycle.

Rehabilitation after knee joint replacement or hip joint replacement is without complications in 80% of cases.

Knee and Hip Replacement Surgery

LIFESTYLE AFTER JOINT REPLACEMENT

For an artificial joint to last for a longer time and work without complications, doctors recommend:

1. Constant moderate exercise.

2. Maintain weight in the norm. Excess weight is an additional burden on the joints and the body as a whole. It promotes the rapid deterioration of implants and prevents them from working properly.

3. Sit in the correct position. This reduces the risk of implant dislocation.

4. Get rid of bad habits. Smoking, alcohol abuse which contribute to osteoporosis resulting in thinning of bones and reducing the life of the endoprosthesis

DURABILITY OF IMPLANTS AND REPEATED REPLACEMENT

The service life of the artificial joint depends on its type and features of the musculoskeletal system of the patient. The joint wears out in 15-20 years. After that, an audit replacement is carried out. Most often, surgeons do not change the entire structure, but only the worn out part.
After the revision, the rehabilitation lasts less than during the initial replacement.


The operation to replace the joint is a radical but necessary procedure. It enables a person to move and live a complete life. To reduce operational risks, trust only experienced orthopedic surgeons.

 

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