All patients requiring joint replacement and having passed the necessary studies to determine the state of the hip joint (X-ray, MRI, ultrasound) are required to undergo a comprehensive examination. This is necessary in order to exclude the presence of possible contraindications.
The complex of diagnostic measures includes:
No special preparatory measures are required before hip endoprosthetics. If no contraindications are found during the examination, the date of the operation is assigned. A light dinner is allowed the night before, but not earlier than 8 hours before the intervention. In the morning, the skin in the area of the hip joint and thigh is carefully shaved. Eating and drinking is prohibited. Before transportation to the operating room, elastic bandaging of the legs is performed, a prophylactic dose of an antibiotic and premedication are administered.
After the patient is delivered to the operating room and placed on the operating table, anesthesia is performed. Usually, the method of anesthesia is chosen by the patient in cooperation with the anesthesiologist. Since the duration of the operation is from 1.5-2 to 3-3.5 hours, either spinal anesthesia or a full-fledged combined anesthesia with controlled breathing and complete muscle relaxation are considered optimal. The first method is less harmful and therefore preferable for the elderly.
After anesthesia, surgeons process the operating field and access the hip joint. The size of the incision, which passes through the central part of the joint, is about 20 cm. After that, the capsule of the joint is opened and the head of the femur is removed into the wound. Its resection is performed along the transtrochanteric line until the medullary canal is exposed.
The bone is modeled in accordance with the shape of the endoprosthesis, which is fixed in it in one of the optimal ways (usually with the help of cement). Then the acetabulum is processed with a drill with a special nozzle in order to completely remove the articular cartilage from its surface. The prosthesis cup is installed and fixed in the prepared funnel.
The prosthetic surfaces are matched and strengthened by suturing the dissected tissue. An active aspiration drainage is installed in the wound, through which the discharge will flow. A bandage is applied.
Hip arthroplasty is a large and complex intervention.
Its complications can be:
Correctly defined indications and contraindications for performing arthroplasty, combined with thorough preparation for the intervention and the sequence of its implementation, minimize the risk of postoperative complications. But you can never exclude them, even if you follow all the rules and recommendations!
According to statistics based on long-term follow-up of the operated patients and the personal experience of leading specialists involved in hip arthroplasty, most patients are satisfied with the treatment results. If the operation is performed in somatically healthy persons of a relatively young age who do not have concomitant diseases, the functional abilities of the hip joint are almost completely restored. This allows a person to walk and exercise. Sports and movements associated with the power tension of the lower extremities are not possible. Patients are either unable to perform them, or in the course of execution, there is a violation of the integrity of the endoprosthesis.
Like any operation, arthroplasty is not complete without complications and unsatisfactory results. They are mainly associated with old age, concomitant diseases and non-compliance by patients with the treatment regimen in the early and late postoperative period. More than 20% of the operated patients expected better results from endoprosthetics in comparison with those obtained.
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