Department of Traumatology and Orthopedics. Endoprosthetics is an operation to replace an affected joint with an artificial one. Endoprosthetics surgery

Total hip replacement has been used in the orthopedic and traumatology department of MONIKI since the 60s of the 20th century. The first implants were all-metal total endoprostheses designed by K.M. Sivasha. We have been using cement total hip replacements made in Europe and America since 1976. Since 1992, the use of cementless endoprostheses of foreign and domestic production began. All historical stages in the development of total hip replacement are reflected in the work of our department. Total knee, shoulder and elbow joint replacement has been used in the department since 1995. At the present stage, the department performs primary and revision endoprosthetics of the hip and knee joints, primary endoprosthetics of the shoulder and elbow joints. Operations are performed for joint pathologies of any degree of complexity.

Osteosynthesis of limb bones

For the first time in Moscow (1960s), the department used and introduced into widespread practice the method of transosseous extrafocal osteosynthesis using the G.A. apparatus. Ilizarov. For the first time in the USSR (since the 1970s), the method of bone osteosynthesis with plates was introduced. Received the Russian Government Prize (1996). The most common pathology is chronic fractures of the bones of the extremities, non-union of fractures, “false joints”, and deformations of the bones of the extremities. Currently, the department performs osteosynthesis with all currently existing external and internal metal structures, from traditional, long-used in practice, to the most modern - plates with angular stability of screws, intraosseous locking rods.

Arthroscopy

The department occupies a leading position in Russia in the development and implementation of high-tech arthroscopic methods for treating injuries and diseases of large joints. Since the early 90s, the department has been performing reconstructive arthroscopic surgeries on the knee, shoulder, ankle and hip joints. Equipping with modern imported equipment, the qualifications of doctors and nurses allow us to perform a wide range of interventions at the level of European and American standards. We are the authors of original, effective methods for treating arthrosis of large joints and instability of the knee joint.

Cooperation with leading American and European manufacturers of arthroscopy equipment, trauma clinics in Russia and Europe, and constant participation in scientific forums allows us to offer our patients the most modern and advanced methods of reconstructive interventions.

Blood replacement technologies

Not a single major operation in traumatology or orthopedics takes place without blood loss. Blood loss can be replenished using two methods: components of donor blood or the patient’s own blood. However, the widespread use of donor blood has revealed serious drawbacks associated with its use: infection with blood-borne infections (including hepatitis B and C, HIV). To replenish the blood lost during and after surgery (via drainages), the department uses: preoperative collection of the patient’s own blood, collection and return of blood spilled into the wound during surgery, collection and return of blood spilled from the drains. For some patients, transfusion of donor blood components is not possible for medical or religious reasons. We use high-tech systems of foreign production. 1 candidate and 1 doctoral dissertation was defended on this topic.

Endoprosthesis replacement surgery is a radical method of treating deforming osteoarthritis, rheumatoid arthritis, aseptic necrosis, post-traumatic complications and malignant neoplasms of the knee joint. Surgical intervention is effective in the last stages of diseases accompanied by chronic pain and persistent impairment of knee mobility.

Direct indication for surgical treatment.

City Clinical Hospital No. 67

It is deservedly considered one of the best clinics in Moscow. World-class doctors work here. Patients are operated on on a commercial basis or at public expense.

City Clinical Hospital No. 67.

To receive a quota for endoprosthetics, a person needs to collect documents and undergo some examinations. After receiving the coupon, he can go to the hospital and get in line. Unfortunately, after this the patient will have to wait several more months for hospitalization.

Hospital named after N.I. Semashko

The facility performs minimally invasive knee replacement surgeries. The hospital is equipped with modern equipment that allows it to perform the most complex operations. Patients who undergo surgery at their own expense can choose an endoprosthesis.

Hospital named after N.I. Semashko.

Fact! There are many private clinics in Moscow offering knee replacements. All of them operate on a commercial basis. However, even there you can undergo surgery for free.

You can have surgery in Moscow for a fee or free of charge, that is, according to a quota. Private clinics have concluded an agreement with the state to provide citizens of the Russian Federation with High-Tech Medical Care at the expense of budget funds. Every Moscow resident can undergo surgery for free in almost any clinic. However, to do this, he needs to rush to apply for a quota and wait in line for 5-8 months.

Paid surgeries can be performed at any clinic that specializes in endoprosthetics. The cost of various surgical interventions ranges from 50,000 to 400,000 rubles. The price of the operation depends on the volume of intervention, the quality of the implant, the level of the medical institution and qualifications.

Applied methods and technologies

In Russia, practically the same tools and equipment are used to monitor the patient’s condition as throughout the world. If you are operated on under a quota, most likely you will be given the cheapest domestic prosthesis.

Table 1. Types of knee replacement.

View	Description	Indications for implementation
Unicondylar	The essence of the operation is to replace the damaged part of the knee joint.	Traumatic or degenerative-destructive lesion of one of the condyles of the femur. The rest of the joint should remain intact.
Total	During surgery, the patient has all articular surfaces changed.	Severe osteoarthritis, accompanied by destruction of the articular surfaces of the femur and tibia.
Audit	The patient undergoes repeat arthroplasty, during which the previously implanted prosthesis is replaced.	It is carried out in case of unsuccessful primary endoprosthetics or in the development of severe postoperative complications.

Video animation of partial technology:

Before endoprosthetics, each patient undergoes an examination and undergoes a series of tests. This makes it possible to identify serious diseases that can cause the development of intra- or postoperative complications. During surgery, the medical staff of any clinic or hospital carefully follows all the rules of asepsis and antisepsis. To avoid undesirable consequences, doctors provide the patient with the prevention of infectious and thromboembolic complications.

Video animation of total technology:

Knee replacement surgery usually lasts 45-60 minutes. If the patient has large condylar defects that require bone grafting, surgical intervention may take 2-3 hours.

On the left is the primary operation, on the right is the revision operation. Please note the difference in implant sizes.

If the operation was successful, the patient begins to move the operated limb and perform special exercises the very next day. After a few more days, he begins to get out of bed and walk with special walkers or crutches. The patient is discharged from the hospital within 5-10 days. Sutures from the postoperative wound are removed on days 10-14. After this, the patient is given recommendations and sent home.

Pros and cons of treatment in Moscow

The advantage of endoprosthetics in Moscow is the opportunity to replace the knee joint free of charge, that is, under a quota. Insurance medicine has its drawbacks - the inability to choose a prosthesis. The government will give you the implant that is available, not the one that is best for you.

An example of wear on a knee implant.

For cash payment you can choose any clinic and traumatologist. They will select the highest quality imported prosthesis that will serve you for many years. But just a few days after the operation you will be discharged from the hospital and sent on a “free swim”. Unfortunately, you will not receive the full rehabilitation package.

Comparison of wear between metal and ceramic femoral implant components.

Let's try to understand more carefully all the pros and cons of paid and free endoprosthetics.

The principle of obtaining a quota

Receiving a quota allows people who do not have sufficient funds for treatment to receive it for free. It is possible that endoprosthesis replacement at the expense of Compulsory Medical Insurance is somewhat inferior in quality to a paid operation. However, it is the only salvation for many citizens of the Russian Federation.

Disadvantages of quota endoprosthetics:

• Lengthy quota registration. To receive a voucher for the provision of medical treatment, you will need to collect all the necessary documentation and pass as many as three medical commissions.
• Long wait for your turn. Once you receive a voucher for free endoprosthetics, you will need to take it to the hospital. There you will be put in a queue, the wait in which can last for six months or more.
• Inability to choose a prosthesis. Since the number of people willing to undergo free surgery is very large, the state is not able to provide everyone with imported prostheses.
• Inability to choose a doctor. The success of the operation depends 99% on the qualifications and skill of the operating surgeon.
• Lack of proper rehabilitation. After the operation, you will stay in the hospital for several days, then you will be sent home. To undergo further rehabilitation, you will have to pay for it out of your own pocket.

Fact! You can get VMP under a quota only at your place of residence. You will most likely be sent to the nearest hospital for surgery. However, you can choose the clinic yourself. To do this, it must agree to operate on you according to the quota and issue a quota decision.

Paid treatment

With a paid operation, you free yourself from lengthy paperwork, standing in queues and months of waiting. When you come to a private clinic, you can calmly choose the doctor, the time of the operation and the implant.

Many people are increasingly going to the Czech Republic for surgery. There you can have endoprosthetics and undergo complete rehabilitation. Naturally, such treatment helps to recover faster and return to your normal lifestyle.

About the importance of rehabilitation

The success of endoprosthetics depends not only on the performance of the operation, but also on the patient’s behavior in the postoperative period. It is good rehabilitation that helps a person restore normal knee mobility.

The rehabilitation period after knee replacement lasts about 4-5 months. All this time, the patient must engage in therapeutic exercises and receive physiotherapeutic treatment.

The hip joint, or articulation, is the largest joint in the human body. Thanks to its functionality, a person is able to move, sit, run, perform and experience various physical activities.

Sectional view of the hip joint. The arrows indicate the blood vessels supplying the cartilage for regeneration. At the very bottom of the picture is the cavity of the femur where the hip endoprosthesis leg is located.

Against the background of such activity or due to pathologies of the musculoskeletal system, the joint wears out and suffers degenerative changes. The patient complains of decreased motor activity and deteriorating quality of life. A fracture of the femoral neck may also occur.

The first thing they resort to is medication, taking anti-inflammatory drugs and local medications. At an early stage of the disease, a therapeutic effect can still be observed, but later such treatment becomes completely meaningless.

Various pathologies of the hip joint, and other degenerative-dystrophic changes, are progressive. It is possible to stop the course of the disease with medication, but soon the pathology will appear again, and the drugs will no longer be useless.

When conservative treatment does not produce results, there is only one conclusion - the disease progresses and requires radical therapy.

On the left is the surface of a healthy joint, it is smooth and not affected by anything. On the right is the last degree of deformation of the cartilaginous surface.

The connective tissue of the joint cannot self-heal or regenerate. Topical or oral medications become a waste of time. will progress until the patient completely loses the ability to move. It is possible to stop the process, but only if you contact an orthopedist in a timely manner.

The main effective and adequate method of therapy is replacing the destroyed articular joint with an implant.

The last stage of coxarthrosis of the left hip joint.

Endoprosthetics is a complex type of orthopedic surgery that requires highly qualified specialists, modern technologies and equipment.

It is difficult to say about this treatment that it is an affordable therapy. You need to understand the difference between the price of prosthetics, i.e. the operation itself, and the cost of treatment, which includes (an important component) the stay in the medical institution itself. is prescribed when other methods of therapy have failed, tissue destruction continues, the disease progresses, and a person loses the ability to move and live normally.

When the attending physician announces the diagnosis and talks about the need for prosthetics, the patient’s first question is: how much does orthopedic intervention cost, where is it best performed, which country to choose?

This is what an x-ray will look like after the hip implant is installed. The second joint is also in poor condition.

How much the surgery and treatment will cost depends on the country and medical institution where it will be performed. The final amount is negotiated personally and depends on many factors.

In addition to the clinic and the country where the intervention will be carried out, you need to take into account the prices for the design -. Cemented implants cost around $1,000; cementless ones, more often used for young patients, cost up to $2,000.

Bone cement is shown in blue.

The first type of prosthesis is recommended for elderly people, since they have significant weakening of bone tissue, pronounced. The second type is assigned to young people: for example, athletes who have suffered a hip injury. This implant is installed in patients under 40 years of age, the reviews are positive.

Price of prosthetics in Russia and abroad

Patients who are not limited in funds prefer to undergo treatment in clinics near and far abroad. In their opinion, prosthetics in the Russian Federation is not yet sufficiently developed, the technological base is weaker, and rehabilitation, as the basis for a successful recovery, has not been popularized.

The cost of replacing a hip joint in cities of the Russian Federation (for example, in Moscow or St. Petersburg) depends on the following points:

• where the medical facility is located;
• technological equipment of the clinic, its modernity;
• level of qualifications of medical personnel;
• what company the prosthesis is used in, the company brand;
• therapeutic measures after implant installation - quality of rehabilitation, professionalism of rehabilitation specialists.

When prescribing a superficial type of replacement, surgery will cost from 80 to 120 thousand rubles, total - a little cheaper. The amount does not include stay at the center and subsequent rehabilitation. Additional amenities will come at a cost. The total cost, including replacement of the hip joint, prosthesis, stay in the ward and the first recovery period, can reach from 250 to 600 thousand rubles.

The numbers are serious - not everyone can afford this. Many are trying to get through at the expense of the state budget. This significantly saves material resources, but there are several significant disadvantages. Firstly, you will need to collect all the documentation confirming the need for prosthetics, then - the waiting period for your turn, which often drags on for a year or more. Secondly, you will be replaced with the prosthesis that will be in the clinic at the time of the operation, which will not give any guarantee of its adaptation, and moreover, it will increase the chances of developing complications.

If financial resources are available, preference is given to foreign medical centers. For example, Israeli clinics, known for high orthopedic technologies and the experience of specialists. Endoprosthesis replacement is considered the most effective here, and the risks of side effects are practically reduced to zero. The basis of surgery is minimally invasive intervention, which makes the procedure as gentle as possible. Robotic systems are also used here, where the risk of infection or bleeding is less than 1%. The success rate of the procedure is 98.5%.

Surgery in such a country will cost an order of magnitude more than in St. Petersburg. The cost without rehabilitation can reach $25,000.

Do not forget about diagnostic measures, which are a generally mandatory requirement. Without tests, the patient is not allowed to undergo surgery. Additional expenses will be required - from $1000 to $4000.

No less popular. Orthopedic departments are equipped with unique equipment and employ only leading specialists. The country's medicine is known for its state-run medical institutions, where the quality of surgery is not inferior to private clinics.

All clinics in Germany provide a guarantee for the prosthesis for 20 years or more, provided that it is used correctly and follows all the doctor’s recommendations.

Has anyone ever wondered what the warranty on a prosthesis is? There are no guarantees!

The tariff will be calculated according to DRG (hospital inpatient pricing). The exact amount will include several prices - surgery, implant, hospital stay. In general, you will have to pay from 7,500 euros. The remuneration for the work of doctors will be calculated separately - from 2,500 euros. Further, mandatory examination starts from 900 euros and additional costs start from 500 euros. The minimum amount that will have to be paid is more than 11,000 euros. This does not include visiting a rehabilitation center - only primary recovery.

There are plenty of good doctors everywhere, but there are often problems with rehabilitation. In the Czech Republic there are all conditions for this.

Recently, centers in the Czech Republic have become popular with the possibility of further rehabilitation at resorts without leaving the country. In the Czech Republic there is a huge selection of rehabilitation centers aimed at restoring patients after diseases of the musculoskeletal system.

Technical capabilities, qualifications of doctors, and quality of medical services are not inferior to Germany or Israel. In some aspects it even has advantages:

• The Czech Republic is a leader in prosthetics; for more than 30 years it was the only country producing endoprostheses;
• Every year more than 10,000 operations are performed in the country, the success rate of which is 98%;
• The quality of surgery far outweighs the price. The cost of surgery will be at least 35% lower than in other countries;
• high level of qualifications of rehabilitation specialists. Czech doctors focus on the recovery period and directly tell the patient that a good operation does not guarantee a complete recovery.

Pricing in the Czech Republic is much more flexible compared to other European centers. There is no need to pay extra: the price of the operation includes the stay and the implantation structure.

The patient is provided with an initial rehabilitation course, the duration of which is on average two weeks, but classes will be carried out in full. Next, rehabilitators will provide a detailed scheme for further recovery at home.

For an operation in the Czech Republic you will have to pay from 10,000 to 12,000 euros, which will include replacement of the hip joint, hospital stay of the patient and an initial course of rehabilitation - two weeks.

The popularity of treatment in Europe is due to different standards of medicine, higher and more innovative. This is especially evident in orthopedic surgery. Thus, in Russia, minimally invasive intervention for joint replacement is not used, since there are no technical possibilities. But it is precisely this that eliminates the development of an infectious process and high blood loss.

Therefore, the question remains: get treatment at a high price and be confident in the outcome of prosthetics, or choose a less expensive treatment method that will not give any guarantee.

Comparison of prices for endoprosthetics in other countries

A country	Procedure	Price
Czech	Replacement of the hip joint with a prosthesis from global manufacturers, taking into account a 10-day stay and an initial course of rehabilitation	From 10,000 to 12 thousand euros
Germany	Private. Prosthetics without long stay and recovery course	From 18 thousand euros
	State hospital. Only surgery, without the participation of a rehabilitation specialist. Stationary stay - no more than 5 days	From 16 thousand euros
Israel	Private medical institution. Prosthesis installation service, no additional services	From 23 thousand $
	State. Surgery service excluding long-term hospital stay and rehabilitation services	From 22 thousand $

Some patients manage to undergo endoprosthetics under a quota - payment is made from the state budget. This service is provided by public hospitals and some private ones. To take advantage of this opportunity, you need to go to the clinic at your place of registration, collect a package of documentation, and submit it to the health committee.

After reviewing the application, if the answer is positive, a coupon is issued. Prosthetics are carried out on a first-come, first-served basis, with a waiting time of six months or more. Implantation is not performed using expensive prostheses; You will be supplied with the one that is currently in stock.

Hip replacement in Moscow

The endoprosthetics service is available not only in Germany or Israel - you can undergo similar treatment in Russia. How much does the operation cost, for example, in Moscow or Novosibirsk? Depends on the location of the clinic, its status, technological base, quality of materials used, and qualifications of personnel. Additionally, the stay in the inpatient department and the course of rehabilitation procedures are paid for.

I wonder if there are people who were operated on under a quota and never paid anyone during treatment?

The largest number of patients go to Moscow city centers. There are a huge number of clinics here that perform this manipulation, and the chance of getting a quota is much higher than in the regions.

Considering that prosthetics is one of the types of high-tech surgery, its cost often exceeds European prices. If traveling abroad is not an option for you, you need to consider. It is recommended to focus on government ones, since they are the ones who provide guarantees for the medical services provided.

Institute of Traumatology and Orthopedics named after N. Priorov

Despite her state status, she has modern orthopedic technologies at her disposal. Surgical interventions are performed by qualified doctors and professors. Prostheses from foreign manufacturers - USA, Germany, Switzerland, domestic - to choose from.

The manufacturer of the prosthesis does not matter - attention should be paid to the friction pair. In this case, a completely ceramic friction pair is shown.

The cost of implantation at the Priorov Hospital reaches 99,000 - 100,000 rubles, depending on the type of implant and length of stay.

Institute of Traumatology and Orthopedics named after N. Priorov.

The institution offers services of primary and revision (re-) prosthetics using prosthetics developed by specialists in the orthopedic department. The introduction of nanotechnology in orthopedics is active here; it is possible to install a structure based on nitride ceramics.

Intensive care wards at the Priorov clinic.

To undergo a free consultation, a referral from a medical institution at your place of registration and a number of documents are required. Commercial reception is carried out by appointment.

Orthopedic Department of the Pirogov Center

Compared to the first one, the price here is significantly lower: installing a prosthesis will cost 50,000-55,000 rubles. One of the few centers offering minimally invasive surgery services. The specialists have a high level of training, high-tech medical equipment, and operating techniques are not inferior to those in Germany.

Pirogov Clinic.

A huge selection of designs is offered for various types of diseases and financial capabilities of patients.

The comparative size of the incisions during the classical operation (left) and minimally invasive (right) is clearly shown. On the left, the size of the cut is slightly exaggerated.

Not every person knows that gonarthrosis is the same well-known arthrosis of the knee joint. The disease is characterized by chronic degenerative damage to the knee joints, where not only the interarticular cartilage tissues are destroyed, but also the bone structures, if the disease is allowed to develop to its extreme stages. Knee problems can occur in one or both of them.

The knee joint is a very complex mechanism, consisting of many small components, with the coordinated work of which, a person moves from place to place at different speeds, squats, stands up, and so on. It is this area of ​​the body that bears the load of the entire human body. Excess weight can be the main cause of the development of a disease such as arthrosis. The initial manifestations of gonarthrosis are invisible, as there is a gradual thinning of the layer of cartilage tissue. With the initial degree of arthrosis of the knee joint, a person almost does not feel any changes occurring in the lower extremities. This phenomenon may begin to cause concern only a couple of years after the onset of the disease, if measures are not taken in time to prevent its progression.

It is mistakenly believed that arthrosis of the knee joint does not threaten young people - they simply do not notice it. An unhealthy lifestyle (smoking and alcohol), frequent injuries, sprains, excessive stress on the body, wearing high heels, strict diets, which provoke a vitamin deficiency in the body, will certainly lead to the development of the disease.

The main symptoms of arthrosis of the knee joint

You should not lose sight of the manifestations of the first signs of such an unpleasant disease as arthrosis of the knee joint, if you do not want to subsequently lose the ability to move freely or resort to a more radical method of treating arthrosis of the knee joint - surgery.

The main symptoms of articular deformity, both knee and hip, are:

Having noted the above, do not delay until later - get examined and begin treatment for arthrosis of the knee joint in order to restore the regeneration of cartilage tissue throughout the body in the initial stages of the disease or slow down its destructive process.

Common degrees of arthrosis of the knee joint

There are three degrees of the disease:

I degree is the initial stage of the disease. Almost not felt by the patient. Occasionally, slight pain occurs when walking or running quickly; sometimes the knee areas become swollen for a short period of time. In a state of rest, nothing bothers you. During the examination, X-ray images already show a certain change - the thickness of the interarticular space has been reduced.

II degree – the inflammatory process is gaining strength. Long-term pain increases, even with little physical activity. Pain relief is achieved by taking painkillers. When bending and extending the leg, limited movement appears, the patient already hears clicks and crunching of the interarticular joints. At the initial stage of detection of arthrosis of the knee joint, a slight deformation occurs, and therefore there is a moderate limitation of motor functions. The load on the legs is not distributed evenly. In places where the cartilage has already disappeared, osteophytes (bone growths) appear, which causes severe pain. X-ray images clearly show the growth of bone inclusions along the edges of the articulation, the interarticular gap becomes thinner.

III degree – characterized by incessant pain. Changes in a person's gait and the appearance of the knee are visible to the naked eye. The patient can hardly bend or straighten his legs. An X-ray image shows an absolute absence of cartilage tissue, a huge amount of pathological bone structure in the joint and destruction of the main interarticular joints. This degree of the knee joint is the most severe; often the only option to help the patient is endoprosthetics.

Treatment for the first stage of the disease

Let us dwell in more detail on the first stage, since it is easier to prevent the disease than to treat advanced arthrosis of the knee joint.

Diagnosis of arthrosis

An orthopedist with extensive experience in medical practice may suspect grade 1 arthrosis of the knee joint based on an external examination and the presenting symptoms. He can receive confirmation of the preliminary diagnosis thanks to a simple x-ray, which shows a slight narrowing of the joint space, which has arisen due to the beginning of thinning of the cartilage tissue. There is no need to undergo more expensive diagnostic procedures, such as computed tomography or MSCT.

The disease can be either bilateral - bilateral arthrosis, or unilateral, for example - arthrosis of the left (right) knee joint or arthrosis of the right knee joint.

Drug treatment

With arthrosis of the 1st degree, you can even begin treatment of the knee joint with home remedies - ointments, creams, medications - chondoprotectors, but to achieve maximum results it will be necessary to resort to clinical help - physiotherapy, manual therapy, the use of intra-articular injections, non-steroidal anti-inflammatory drugs.

Before starting treatment for arthrosis of this degree of the knee joint, it is necessary to seek the advice of an orthopedist, because the objectives of treatment include:

• body weight correction,
• correctly selected drug treatment that is suitable for you,
• a set of physical therapy exercises,
• a certain type of massage,
• physical therapy or manual therapy.

The doctor will tell you how to adhere to the diet correctly so as not to cause more damage to the cartilage tissues of the body and at the same time lose weight, which will reduce the load on the patient’s lower limbs.

Taking chondoprotectors helps relieve joint pain, restore (that is, regenerate) cartilage tissue, and strengthen interarticular cartilage. This type of drug contains glucosamine and chondroitin sulfate, which affect cartilage tissue. The most well-known drugs are: Dona, Chondrolon, Teraflex, Structum, Chondroxide (in the form of tablets and ointments). To achieve the best results, it is recommended to undergo several courses of treatment with chondoprotectors, in combination with physiotherapy and therapeutic exercises.

Physiotherapy

An individual set of physical therapy exercises is the most important process in the treatment of early-stage arthrosis. As noted above, nutrition of cartilage tissue occurs precisely at the moment of movement of the joint. That is, the best regeneration will occur when taking chondoprotectors and exercising, as blood circulation in the tissues improves, thereby achieving rapid delivery of necessary nutrients throughout the body. Gymnastics will also help strengthen the leg muscles, so the load will also fall on the muscle tissue. After physical therapy exercises, massage is performed to achieve better results from manual therapy.

Practical advice from the best chiropractor Vitaly Demyanovich Gitt.

Physiotherapy

Physiotherapeutic treatment for arthrosis may include:

• magnetic therapy – applied locally, stimulates regenerative processes, improves blood circulation in the joints,
• electrophoresis – medications are administered locally, which facilitates their direct delivery to the affected area, thereby accelerating the recovery process,
• Ultrasound influence – helps to improve the functioning of cellular metabolism.

Conclusion

You should not resort to all of the above treatment methods on your own for early-stage arthrosis. It may be excessive or insufficient, which can lead to further development of the disease. If you follow the recommendations of the attending physician, the dynamics will be monitored and, in accordance with its results, the doctor can make adjustments to the treatment plan and thereby relieve you of the disease or slow down the development process.

Knee replacement: rehabilitation after surgery, complications

Endoprosthetics is a surgical operation in which a person’s damaged or destroyed joint is replaced with an artificial analogue.

Replacement of joints with artificial implants is indicated for patients for whom a complex of conservative treatment has not brought results, and the damaged joint cannot function normally.

As a rule, prosthetics are performed against the background of severe forms of arthrosis or after a serious injury to the joint. The cartilage pad that exists between the bones of the joint wears out, preventing the knee from working normally.

There are several other causes of osteoarthritis:

• rheumatism,
• metabolic disorders,
• infections.

The purpose of the operation is to reduce pain and restore the functionality of the joint. The structure of the prosthesis closely follows the natural architecture of the joint. Modern dentures are made of metal and ceramics; they last up to 20 years; after they become obsolete, they are replaced with new ones.

To fully resume your normal lifestyle after knee or hip replacement, it is not enough to undergo a total surgical intervention.

After the operation, rehabilitation is necessary.

The first day after endoprosthetics

If endoprosthetics was successful and there are no contraindications, then within a few hours after surgery the patient can sit down. You can hang your legs off the bed and get up only on the second day.

You need to be prepared for the fact that the rehabilitation period will take at least three months. This time is purely individual and depends on the age, weight and general condition of the patient.

To prevent a blood clot from appearing, the patient should definitely wear special stockings or use an elastic bandage.

For a quick recovery, you must follow all medical recommendations and do a set of exercises that are designed specifically for people after knee replacement.

In order to get out of bed correctly for the first time after surgery, it is important to know the following rules:

• you need to stand on the side of the healthy limb,
• before getting out of bed, the leg should be extended forward and not bent,
• When lifting, you need to rely only on crutches and your healthy leg. For the first time, it is best to carry out the procedure together with a doctor, and stand up, leaning on another person,
• the floor should not be slippery to avoid burning and damage to the operated limb.

The patient should take the first steps as carefully as possible. Do not put any weight on the operated leg; it is lightly touched to the floor. The load on the joint should increase gradually, every day.

After knee replacement, the person remains in hospital for several more days to exclude unexpected changes in condition.

At this time, doctors monitor the patient’s general well-being and teach him the necessary set of gymnastic exercises, which the person will then do independently at home.

In addition to independent exercises, doctors prescribe the patient a course of therapeutic and preventive exercises - exercise therapy.

Exercises after knee replacement

Only if you perform daily special exercises will the normal functioning of the knee be restored and complications excluded. After the operation, the person must take painkillers for several days; exercises are carried out after the doctor’s permission.

Later, any gymnastics is performed without taking painkillers. These medications reduce sensation levels, which can lead to unexpected knee damage.

Gymnastics complex:

1. Flex and straighten the ankle joint. Each exercise is repeated five times, then the number increases to 20 times as recovery progresses.
2. Tighten the anterior thigh muscles and keep them toned for 2-5 seconds. Do the same with the back muscles of the thigh,
3. Hold your gluteal muscles tense for about 5 seconds,
4. In a lying position, raise your straight legs at an angle of 45 degrees and hold them for about 5 seconds,
5. Move your hips to the side several times
6. Move the straightened prosthetic leg back.

It should be noted that all procedures are necessary for the restoration of the knee joint to take place in a short time. Exercise therapy is a procedure that is also initially characterized by pain and discomfort; it is important to strictly follow the doctor’s recommendations and perform the exercises.

Sometimes exercise can cause swelling in the operated leg, which can be relieved with a cold compress. During the recovery period at home, it is best to supplement therapeutic exercises with physical activity:

1. cycling,
2. swimming,
3. massage.

All this stimulates the muscles and enriches the blood with oxygen, which promotes successful tissue healing and prevents various complications after knee replacement.

At the same time, the prosthetic limb should not be subjected to heavy loads.

Contraindications

After knee replacement and a rehabilitation period, most people return to a normal lifestyle. It is important to follow some rules that will help you successfully recover and extend the life of the endoprosthesis.

After surgery, doctors advise you to gradually carry out your usual activities. Can:

1. to drive a car,
2. do a little work at home,
3. walk up the stairs.

Despite the fact that quick recovery requires gymnastic exercises, exercise therapy and walking, doctors prohibit the following types of physical activity:

• jumping,
• aerobics
• some sports: tennis, skiing, etc.

Any type of knee or hip replacement does not involve lifting heavy objects.

Pain is completely normal after knee replacement. In the period after surgery, you should not abuse painkillers. The pain is relieved by a compress or relaxing massage.

It is important to remember that developing the knee joint is the best way to get used to the prosthesis.

The leg will not hurt when the body gets used to its condition and muscle activity is restored.

Rehabilitation and complications

Each person’s body has its own characteristics, and it is possible that complications may arise after joint replacement.

Sometimes after replacement the joint is also unstable and additional surgery is necessary to correct the situation. After surgery, the wound may become infected and the patient is prescribed antibiotics.

For six weeks after surgery, there is a risk of swelling and blood clots, so you will need to wear special stockings and take blood thinners.

Rehabilitation after knee replacement includes exercise therapy, this helps normalize blood circulation in the legs, and a special massage relieves swelling.

After surgery, there is a possibility of a fracture or crack in the bone near the implanted implant. During the healing period, scar tissue appears, which can cause limitations in joint mobility; it is removed surgically.

The kneecap may become dislodged; it can only be put back in place through surgery. There is also a risk of deformation of the artificial implant itself.

For some time, the postoperative scar and adjacent skin will have reduced sensitivity and numbness.

The rehabilitation period and knee replacement are serious processes, so it is important to follow all medical recommendations and responsibly perform the necessary exercises at home or in a sanatorium.

The prosthesis makes it possible to lead a normal lifestyle. However, there are still certain motor limitations.

Many sanatoriums offer rehabilitation procedures after endoprosthetics. But not all courses have a set of equipment, so it is important to carefully choose a place where total restoration of the condition will be ensured.

Many patients prefer to visit sanatoriums abroad. Such sanatoriums offer patients a full range of services, they have modern equipment, and the medical staff has the entire base of necessary skills.

The cost of services that provide total limb restoration in a sanatorium is quite moderate, which is why such establishments are traditionally popular and in demand.

Disability and rehabilitation after knee replacement

For diseases that destroy joints and bone tissue, patients are entitled to disability benefits. To obtain it, you need to collect all the necessary documentation, photographs, as well as a medical certificate stating that the person cannot perform full independent movement.

Rehabilitation after knee replacement may also result in disability status if the patient is unable to move at the level necessary to perform activities.

Social assistance is provided for 1 year. To extend payments, after this period you need to undergo a second examination procedure, providing documents to a special commission on disability.