Total Hip and Knee Joint Endoprosthesis
Anatomy of the hip joint
The hip joint is a spherical joint in which it articulates the pelvic hole (acetabulum) and the femoral head of the femur. The contact surfaces of these bones are covered with hyaline cartilage. The area of the hole forms its bone part, at the edge of which cartilaginous labrum. The hip joint is statically stabilized by a strong articular sleeve and a dynamic muscular cloak. Important muscles in standing and forward movement are mainly gluteal muscles, iliopsoas and hamstrings. There are important nerves on the front and back of the joint. After the hip joint front, there are blood vessels that supply the entire lower limb.
Arthritis of the hip (coxarthrosis)
It is a degenerative, non-inflammatory affection of hyaline hip joint cartilage, manifested initially by pain in movement and stiffness of the joints. Later, resting pain appears. Typical is also starting pain at the beginning of movement and in the morning. Arthrosis of the hip affects over 10% of the population.
Primary coxarthrosis - arises from a metabolic disorder of cartilage
Secondary coxarthrosis - the cause of arthrosis is not primarily on the metabolic background.
The cause may be
- Developmental dysplasia of the joint
- Rheumatoid arthritis, Bechterew's disease
- Post-traumatic disability after infectious complications
- Conditions following aseptic necrosis (Perthes, corticosteroids)
On X-ray imagery, arthrosis is manifested by gradual narrowing of the joint, increased peripheral osteophytes, subchondral sclerosis, sometimes through the formation of subchondral cysts with the possibility of bone necrosis.
We divide arthrosis by four-stage X-ray according to Kellgren and Lawrence (1957):
- Stage I: narrowing of joint joint medically, beginning of osteophyte formation
- II. Stadium: certain reduction of the articular slit inferiorly, distinct osteophytes
- III. Stadium: articular slit markedly narrowed, osteophytes, sclerotic changes of detritus cysts, deformation of the head shape and acetabula
- IV. Stage: Clearing of the joint with sclerosis and cysts, advanced deformation
Treatment of coxarthrosis
In the early stages of coxarthrosis, we mainly use pharmacological and rehabilitation procedures. We emphasize the adjustment of sports activities. Cycling and swimming are particularly suitable. It is important to keep the patient's optimum weight so that the supporting joints are not overloaded. Drugs are recommended in medication especially from a range of non-steroidal anti-inflammatory drugs.
At advanced stages of hip arthritis, it is important to evaluate the clinical condition and consider the possibility of surgical procedures. Consider arthroscopic treatment of femoroacetabular impingement (syndrome of obstruction of rounded outbursts) or osteotomy of the upper extremity of the femur. In the advanced stage of arthritic hip disease, it is often necessary to undergo total endoprosthesis (TEP) implantation.
Artificial joint - alloplasty - total endoprosthesis (TEP)
Aloplasty of the hip joint is replacement of the damaged joint with an implant, replacing the acetabulum well with the femoral head.
- bone cement fixed polyethylene well
- bone cement fixed stem
- uncemented well - usually titanium
- bone cement fixed stem
- well uncemented
- shank uncemented
An insert that forms a sliding surface is inserted into the anchor well and the endoprosthesis head is attached to the stem of the stem. The materials used to make the sliding surfaces are especially CrMoCo steel, polyethylene, ceramics and oxinium.
The patient should be thoroughly preoperatively examined before joining alloplastics. On the way to our Grand Class ambulance, we perform standard preoperative examinations (ECG, laboratory examinations, heart and lung x-rays), dental examinations, gynecological and urological examinations. In the preoperative period, it is necessary to modify the medication that affects blood clotting. The patient is provided with underarm crutches and medications to prevent thromboembolic disease.
The time spent by the patient in the operating room is about 120 minutes. The entire patient is accompanied by an anesthesiologist with an anesthesiologist. In most cases, hip joint alloplasty is appropriate in spinal anesthesia, ie in the patient's condition during conscious operation. Only the operated limb is unresponsive. In order to stimulate a pleasant atmosphere, patients are given calming drugs. The patient can listen to his favorite music during surgery. The actual surgery takes about 90 minutes. We use recuperation to compensate for blood loss, when the blood drawn from the wound is returned to the bloodstream after treatment. There is often no need for foreign blood transfers or for self-transfusion.
From the operating room, the patient leaves for the postoperative department (ICU), where his condition is monitored for about 24 hours. Further treatment usually takes place on standard and above-standard beds of our facility. Throughout the postoperative course of the patient, an experienced physiotherapist attends rehabilitation. Within a week, patients are so mobile and self-sufficient that they can be transferred to another workplace. Removal of wound sutures is recommended 12 - 14 postoperative day. Patients go to our outpatient clinic for regular checkups 1, 3, 6, 12 months after surgery. In the period of one year after TEP implantation they have the option of taking a bath in the spa. Subsequently, they are regularly monitored at an annual interval.
Complications and risks
Complications can occur after each surgery, but they are able to reduce their number to a minimum by modern techniques, materials, and a high level of specialist physicians. The most common complication of hip aloplasty is secondary healing and prolonged serous leakage. In most cases, this condition is managed by regular wound prevalence and, possibly, By administering antibiotics. If inflammative parameters develop, infective agents are cultured, it is sometimes necessary to undergo a revision operation of the joint and remediation of the infection. TEP deviation occurs especially within 6 weeks of TEP implantation. During this period, the soft tissues are not adequately healed. Therefore, patients are consistently informed about post-operative RHB positions in the postoperative period that should be avoided in the early postoperative period.