Consequences of hip replacement. Why does my knee hurt after hip replacement? Prevention of undesirable consequences

Persistent pain after hip surgery is associated with swelling of the muscles that allow hip movement. These muscles were the cause of pain before endoprosthetics and continue to cause discomfort after. And all because, being swollen, they compress the nerve endings located near them and the joint. If muscle swelling is eliminated, post-operative hip pain will disappear. With this, the recovery period will be much easier.

Treatment using the Nikonov method on muscles

To solve a problem, you need to know exactly the cause of its occurrence.

Myologist Nikolai Borisovich Nikonov, over 30 years of practice, has determined that muscle cells, being swollen, exert strong pressure on the joint and the nerve endings located near it. In this case, the patient may feel severe pain in the groin or leg. This happens even before surgery, so the operation does not bring any results. Modern medicine refuses to accept swelling in the muscles as a cause of pain. Therefore, a large number of people go under the knife. With this comes a significant waste of money, time and effort. The recovery process after surgery is long and painful. But as a result of this treatment, the pain after hip replacement does not go away!

Nikolay Nikonov

The only way to remove swelling is to apply the Nikonov method to the muscles with fixation of the problem muscle. With certain manual movements I develop a tight muscle. In the process of complex procedures, a sharp outflow of lymph from the cells is caused, which turns into a sharp influx to its walls. At this point, waste products accumulated in the cells are eliminated and they decrease in size. As a result of treatment, pain disappears after hip replacement. Practical example on video.

It’s enough to experience daily discomfort! Contact Nikolai Borisovich for help. The specialist has helped hundreds of patients and this is confirmed by numerous

It is impossible to completely eliminate pain after endoprosthetics, but there are ways to minimize it. The joints become inflamed and swollen if you do not follow the rules of recovery, take medications chaotically and, feeling sorry for yourself, do not develop the operated leg. The qualifications of the doctor are also of great importance.

Why does pain return after surgery?

It makes it possible to return to normal life and get rid of the symptoms of arthritis that have bothered you for many years. Practice shows that complications after surgery occur in 1% of young and 2.5% of elderly patients. Pain after hip replacement is one of the most common complications. This symptom is caused by non-compliance with the rules of physical activity or insufficient care in the postoperative period. Less commonly, the cause of complications is surgeon error.

What do the statistics say?

According to medical research, knee replacement is fraught with:

• 1.93% - dislocation;
• 1.37% - infection and subsequent septic inflammation;
• 0.3% - the formation of blood clots;
• 0.2% - fracture of the prosthesis.

The patient's condition worsens after discharge, when there is no proper supervision of the medical staff and the patient begins to gradually weaken the regimen. If after a sufficient amount of time the range of motion of the limb is minimal, the joint is still swollen, this indicates a lack of proper rehabilitation and non-compliance with medical recommendations.

It is impossible to avoid painful manifestations even with the most highly qualified surgeon. During the operation, the adjacent muscles are cut and re-sutured. Restoring movement in the knee or leg is associated with pain. However, its appearance may indicate the development of complications.

What other complications are possible?

Immediately after surgery

Pain after hip replacement also causes:

The knee prosthesis can become dislodged if it is bent at a 90-degree angle.

• Wound infection during surgery. Occurs both on the surface and in soft tissues. The operation site hurts for a long time, swells, and turns red. It can be cured with long-term use of antibiotics. Therapy should begin as quickly as possible, otherwise a repeat operation to replace the joint will have to be performed.
• Implant rejection. It occurs very rarely, since before the operation allergy tests are carried out to determine the tolerance of the material of the future prosthesis. Implants are made by many manufacturers, and choosing the most suitable one is not difficult.
• Displacement of the prosthesis. It appears if the patient does not comply with the recommendations of the attending physician to limit movements and exercise. After knee replacement or hip replacement, bending the leg at an angle of more than 90 degrees is fraught with a similar complication.
• Deep vein thrombosis. Due to restricted movement after surgery, blood stagnates in the veins. This can lead to blood clots. Depending on the size of the blood clot and the direction of blood flow, the patient may experience gangrene of the legs, heart attack, or pulmonary thromboembolism. To prevent this complication, it is important to start doing gymnastics in a timely manner. From the 2nd day after surgery, the patient begins taking anticoagulants.
• Changing leg length. It appears when the prosthesis is installed incorrectly. The nearby muscles weaken, so exercise is extremely important.
• Bleeding. Appears due to medical error. Help must be provided immediately, otherwise there is a high probability of hemolytic shock and death of the patient.

After a certain period

Over time, in addition to pain, there is a possibility of complications that can only be eliminated by replacing the hip joint prosthesis:

• lameness;
• dislocation of the implant head;
• destruction of the prosthesis (complete or partial);
• weakening and deterioration of joint functionality.

The more accurately the rules of rehabilitation after joint replacement are followed, the lower the risk of complications.

What treatment methods can be used?

We fight pain after endoprosthetics at home

• While resting, keep the operated leg slightly elevated. This reduces swelling, the hematoma goes away, and the joints hurt less. The knee should not be unduly strained or extended. To increase blood flow, you need to periodically change your body position and move frequently. To prevent blood clots, you can wear compression tights or stockings.
• If after surgery the joint is painful and inflamed, to eliminate these manifestations, apply ice around the incision for 15-20 minutes every 3 hours. This reduces muscle pain. To prevent tissue frostbite, it is recommended to wrap ice in gauze or a towel. Manipulation is especially effective if the joints are swollen.
• Move with the help of crutches. This reduces stress on the hip or knee. Until the muscles become stronger, you need to fully rely on the operated limb under the supervision of a doctor.
• All prescribed medications must be taken at the frequency prescribed by the doctor and in the prescribed dosage.
• When the operation site begins to hurt less and the swelling in the buttocks, thigh or groin subsides, it is recommended to warm up the joint. This dilates the veins and promotes better mobility.

Negative consequences and complications after hip arthroplasty (HJ) occur infrequently, but they are not excluded. In the postoperative period, the patient may experience inflammation accompanied by a bacterial infection. Due to non-compliance with the doctor’s recommendations, dislocations and fractures of the prosthesis, blood clots and other disorders occur. If after endoprosthetics surgery a person feels worse, you should not expect the situation to normalize on its own. Only timely medical care will help prevent serious complications.

Causes of complications after hip replacement

The operation is complex and traumatic, so it cannot always take place without negative consequences. To reduce the risk of complications, it is important to follow the doctor’s recommendations during the rehabilitation period after endoprosthetics. The following are at risk for postoperative disorders:

• elderly people over 60 years of age;
• those suffering from systemic pathologies, such as diabetes, arthritis, psoriasis or lupus erythematosus;
• patients with a history of fractures or dislocations of the hip joint;
• patients suffering from chronic inflammatory diseases;
• violating the advice and recommendations of the surgeon.

In older people, complications after knee or hip replacement develop due to physiological characteristics. Due to the fact that as the body ages, joint structures become thinner and destroyed, older people are at greater risk of experiencing negative consequences. During the rehabilitation period, young men and women must use special devices when moving, because walking without crutches can cause dislocations or fractures of the prosthesis.

Types and symptoms

Paraprosthetic infection

If a person has a fever after hip replacement, swelling, a purulent fistula has formed and is experiencing severe pain in the thigh, most likely an infection was introduced into the wound during the operation. For such symptoms, the doctor prescribes antibiotics and auxiliary products that can help relieve inflammation. If the temperature persists for a long time, and the patient does not consult a doctor and does not take any measures, repeated, revision endoprosthetics of large joints is possible.

Dislocations and subluxations

They often develop in late rehabilitation periods, when the patient ignores physical limitations and early refuses to move on crutches. Due to the increased load, the femoral component is displaced in relation to the acetabulum, causing the head to misalign with the cup. The damaged area swells and hurts, the person cannot take some familiar positions, the leg loses its functionality, and lameness is observed.

If discomfort has just begun to appear, it is better to immediately visit a doctor; the sooner you begin to eliminate the problems, the less consequences there will be.

Neuropathy

If nerve fibers are damaged during surgery on the hip joint, neuropathic syndrome develops. This complication may be a consequence of lengthening the leg after installation of the implant or pressure on the nerve endings of the resulting hematoma. The main symptom of neuropathy is acute pain that spreads to the entire lower limb. Sometimes it feels as if the foot is numb or there is a burning sensation and a feeling of goosebumps running across the skin. With such symptoms, it is dangerous to endure pain and self-medicate. If you consult a doctor in a timely manner, you will be able to normalize your health with the help of physical exercises, otherwise you cannot do without surgery.

Periprosthetic fracture

After replacing the hip joint, the integrity of the bone structures of the hip may be damaged in the place where the endoprosthesis leg is fixed. This is often a consequence of decreased pelvic bone density or poorly performed endoprosthetic surgery. If a fracture occurs, the person experiences severe pain, swelling and hematoma form at the site of the injury, and the functionality of the joint is impaired.

Thromboembolism

The first days after endoprosthetics, the patient will be partially immobilized, as a result of which the blood flow in the veins and arteries will be disrupted. This leads to critical blockage of blood vessels with a thrombus. Often the condition does not have pronounced symptoms, so it is important to control blood circulation and not violate the doctor’s recommendations during the postoperative recovery stages. Sometimes, with thrombosis, the patient notices that the limb hurts and is swollen; shortness of breath, general weakness, and loss of consciousness may also bother.

Other consequences

Complications during endoprosthetics can be very diverse. One of the most common is the body’s rejection of the implant. After prosthetic surgery, the body may react inadequately to foreign material, resulting in inflammatory and allergic reactions. Swelling, suppuration and fistulas form at the implantation site. In addition, a person may experience:

• blood loss;
• loosening of the prosthesis structure;
• lameness;
• groin pain;
• edema, due to which the legs swell so that the function of the joint is completely impaired.

Treatment and rehabilitation of orthopedic patients with degenerative lesions of the hip joint are important medical, social and economic problems. Pathology of the hip joint remains the most common cause of temporary disability, and disability, according to various authors, ranges from 7 to 37.6% of all disabled people with lesions of the musculoskeletal system.

In recent decades, total arthroplasty has become one of the main methods of treating severe pathological changes in the hip joint, allowing to restore the weight-bearing ability of the hip, achieve a sufficient range of motion, relieve the patient of pain and lameness, and return him to an active lifestyle.

The use of modern technologies has made a significant leap in joint replacement. Using the latest generation of implants, many authors note a significant increase in their “survival” period.

Every year, up to 1,500,000 total hip replacements are performed worldwide.

Endoprosthetics statistics

According to statistics, in developed countries there is one large joint replacement surgery per thousand people. In Russia, the need for hip replacement surgery, according to preliminary calculations, is up to 300,000 per year.

The use of joint replacement in each specific case makes it possible to optimally solve complex problems in quickly relieving pain, restoring mobility in the affected joint and the ability to support the limb, and returning the ability to self-care.

Despite the immediate successes of surgical treatment, according to foreign sources for the observation period after 1 year and 5 years, positive results after endoprosthetics are observed in 76–89% of cases. In patients with a unipolar endoprosthesis, the pathological process, as a rule, progresses due to abrasion of the acetabulum cartilage and leads to deterioration of limb function and pain. Some patients after total endoprosthetics also develop pain syndrome in the long-term period due to various reasons.

One of the reasons that significantly reduces the “quality of life” of patients is pain after hip replacement.

Even experienced doctors are not always able to differentiate pain and prescribe adequate treatment, without knowing the clear etiopathogenesis of the pain syndrome in each specific case.

According to the literature, the most studied pain syndrome is the instability of the endoprosthesis, most often associated with the occurrence of micromobility of the components of the endoprosthesis in the bone bed and the development of infection.

The appearance of pain in the groin and buttock areas, which intensifies when the patient is sitting, most often indicates the involvement of the acetabular component of the endoprosthesis.

Pain along the anterior surface of the thigh and in the groin area, especially aggravated by load and rotational movements, indicates instability of the femoral component of the endoprosthesis. Typically, pain associated with developing instability radiates to the knee joint, as with coxarthrosis.

Pain after endoprosthetics can also occur in the presence of an infectious process in the joint area.

Pain syndrome occurs in 90% of such patients. It is often difficult to distinguish instability of the prosthesis (usually one of its components, for example, the femoral component of the hip joint endoprosthesis; this process is aseptic) from manifestations of infection. Pain due to instability occurs or intensifies with movements in the affected joint or attempts to load the operated limb. Pain with infectious complications is constant, its intensity increases over time, but also intensifies with movement and stress. In addition, they experience constant low-grade fever and changes in blood counts.

Standard methods are used to prevent infection, but when differentially diagnosing the causes of pain, it is important to take into account the presence of infectious processes (upper and lower respiratory tract, infectious lesions of the teeth) in the long-term postoperative period as a possible probability of hematogenous dissemination of infection into the joint.

In some patients, after surgery, vertebrogenic pain persists in the projection of the hip joint or in case of systemic diseases (osteoporosis, etc.). We noted that when restoring the length of the limbs, pain in the lumbosacral region and the posterior surface of the elongated thigh is disturbing, associated with the alignment of the previously skewed pelvis and the inevitable change in the ratio of the anatomical structures of the lumbosacral region, which often leads to exacerbation of osteochondrosis. The localization of pain in this case may vary depending on the various segments of the spine involved in the adaptation process.

Currently, the problem of pain in the hip joint after endoprosthetics remains insufficiently studied, excluding the reasons discussed above, as evidenced by the small amount of literature data. In authoritative publications of world literature, there are mainly references to the presence of pain, while their etiology and pathogenesis have not been studied.

Data from foreign authors

According to foreign authors, pain syndrome in patients who have undergone total hip replacement surgery remains in 17–20%, and in 32–35% new sensations are noted from mild pain or discomfort in the hip joint to severe pain in the absence of instability and infection. process.

Based on the results of the final reports of the Swedish Register for 2002–2006. The reasons for revision hip arthroplasty in 1.2% of cases is pain.

A year after primary endoprosthetics, 14–22% of patients complain of pain, and after 10 years – about 30%.

Based on reports from the Danish Arthroplasty Registry for 1998–2003. 3.2% of patients develop severe pain 6 months after surgery.

According to research from an orthopedic clinic in Salt Lake in 2004, in most cases, pain after primary endoprosthetics occurred due to excessive offset, which subsequently led to the development of tensopathy or trochanteritis. According to our studies, with excessive offset, patients complain of nagging pain in the projection of the greater trochanter and iliac wing, which intensifies with flexion and adduction. In more severe cases, there was abduction contracture. In addition, when installing an endoprosthetic leg with insufficient offset, the localization of pain is identical, but its intensity is more pronounced, associated with muscle tension, up to muscle spasm, since more effort is required to keep the pelvis in the correct position. In extreme cases, a positive Trendelenburg sign developed.

American scientists V. Jasani and P. Richards in 2002, while monitoring patients in the early postoperative period, revealed that one of the causes of pain was a hematoma in the m. psoas.

In addition, according to the Australian orthopedist J. Herald, after hip replacement, stenosis of the superior and inferior gluteal arteries quite often occurs, and this is the cause of pain in the groin area.

European authors described pain in the groin area after endoprosthetics, which is associated with tension or damage and injury to the m.iliopsoas. In the first case, pain occurs when the lower limb is lengthened. In the second, the cup of the endoprosthesis, when it is not covered enough, comes into contact with the fibers of the m.iliopsoas, causing their damage.

This leads to pain in the groin area during flexion and external rotation. According to the authors' observations, in 62% of cases pain occurs during cement installation of a cup.

As personal experience shows, pain of this nature can be caused by a defective position of the acetabular component. When the endoprosthesis cup is in a vertical position, pain occurs during walking, most often in the groin and anterior outer surface of the thigh in the projection of the hip joint. With insufficient frontal inclination of the acetabular component, pain appears in the groin and gluteal regions during internal rotation and in the “standing on all fours” position.

Pain may occur if the femoral component is installed incorrectly.

Installation of the endoprosthesis leg in a varus or flexion position causes pain along the anterior outer and posterior surfaces of the thigh in the projection of the distal end of the endoprosthesis leg. The pain intensifies with load on the limb, gradually becoming more pronounced and intense. An x-ray of the proximal femur against the background of the varus position of the endoprosthesis reveals hypotrophic, less often hypertrophic (stress schilding) changes in the cortical bone in the area of ​​local contact with the stem.

Most often, instability of the femoral component gradually develops, which is most typical for endoprostheses that are not provided with a structured surface.

Other pain factors

In addition to the pain described in a few literary sources, it is necessary to note some other etiopathogenetic factors that can cause pain.

Thus, during the first two weeks after surgery on the hip joint, quite often patients complain of pain in the knee joint. At the same time, the joint itself is not externally changed, its palpation and movements in it are painless.

Such pain is a characteristic symptom both for hip joint disease in general and in the immediate period after hip replacement. This symptom is most often noted during unipolar endoprosthetics.

The reason for their appearance is probably irritation of the sensitive nerve fibers of the branches of the obturator nerve located in the ligament of the femoral head and the fatty body filling the acetabulum fossa.

In addition, with long-term pathology of the hip joint of a congenital or acquired nature, an adaptive stereotype of movements is formed, both in the joint itself and in the elements of the musculoskeletal system involved in the walking process. In addition to changes of a functional nature, anatomical changes gradually form (muscle retraction, scoliotic deformity, lumbar lordosis, pelvic distortion, rotational deformity of the lower limb, flexion adductor contracture, etc.), which, after replacing the joint with an artificial one, find themselves in conditions requiring the opposite development.

Thus, due to insufficient consideration of this problem in the literature, the creation of algorithms for the diagnosis and prevention of pain after hip replacement is relevant and of great interest, since relief from pain is the dominant motive in the patient’s consent to surgical treatment.

Currently, due to the widespread development of endoprosthetics in the world, priorities regarding the results of the operation have changed.

According to leading experts in this field, improving the “quality of life” of patients is the main goal of endoprosthetics.

Consultation on treatment using traditional oriental medicine methods (acupressure, manual therapy, acupuncture, herbal medicine, Taoist psychotherapy and other non-drug treatment methods) is carried out at the address: St. Petersburg, st. Lomonosova 14, K.1 (7-10 minutes walk from the Vladimirskaya/Dostoevskaya metro station), with 9.00 to 21.00, no lunches and weekends.

It has long been known that the best effect in the treatment of diseases is achieved with the combined use of “Western” and “Eastern” approaches. Treatment time is significantly reduced, the likelihood of disease relapse is reduced. Since the “eastern” approach, in addition to techniques aimed at treating the underlying disease, pays great attention to the “cleansing” of blood, lymph, blood vessels, digestive tracts, thoughts, etc. - often this is even a necessary condition.

The consultation is free and does not oblige you to anything. on her All data from your laboratory and instrumental research methods are highly desirable over the last 3-5 years. By spending just 30-40 minutes of your time you will learn about alternative treatment methods, learn How can you increase the effectiveness of already prescribed therapy?, and, most importantly, about how you can fight the disease yourself. You may be surprised how logically everything will be structured, and understanding the essence and reasons - the first step to successfully solving the problem!

Exercise therapy after hip replacement helps restore its functions. The hip joint provides the connection between the legs and torso of the human body. It bears a huge share of the load, so in case of diseases, injuries and lesions of this joint, acute unbearable pain is felt, which requires immediate medical intervention. One of these interventions is carried out during hip replacement. It consists of replacing the destroyed joint element with an artificial implant, which ensures smooth and painless rotation of the joint. The prosthesis can be made of various materials. Metal or ceramics are used, as well as stainless steel, cobalt, chrome or titanium. Based on the patient’s individual characteristics, the surgeon selects the material and size of the hip joint prosthesis.

This type of surgery is offered to people who have undergone all types of conservative treatment to no avail. Such intervention is permitted when:

• rheumatoid infectious arthritis of the hip joint;
• pathologies of blood supply to bones;
• joint dysplasia;
• deforming arthrosis of the hip joint;
• aseptic or avascular necrosis of the femoral head bone, which results in partial death of bone tissue;
• impaired limb function and pain due to the ineffectiveness of previous treatment;
• damage to the hip joint as a result of rheumatic diseases;
• fibrous ankylosis, when fibrous tissue grows, causing stiffness and, as a result, complete immobility in the hip joint;
• bone ankylosis, when bone tissue grows, leading to joint immobility;
• damage to the joint, resulting in shortening of the limb;
• dysfunction of the joint due to traumatic changes.

With arthrosis of the hip joint, the articular surfaces are deformed and cartilage tissue is destroyed. This disease causes severe pain that interferes with free movement, and, as a result, a person loses an active life. The disease mainly manifests itself in old age, but can also be diagnosed in young people, manifesting itself as a result of injuries or congenital pathology in the structure of the joint.

Rheumatoid infectious arthritis, or coxitis, which is classified as a chronic autoimmune disease, occurs in both young and elderly people. It affects joints and other organs and systems of the body. With rheumatoid infectious arthritis of the hip joint, inflammatory-dystrophic phenomena occur, leading to stiffness and stiffness.
In the case of a fracture of the femoral neck, the consequence may be hip replacement. Such fractures often occur in older people. It happens that they do not grow together, and then one of the safe ways out of the situation may be the implantation of an implant. After surgery with the help of exercise therapy for a pelvic fracture and proper care, the prosthesis allows older people to get back on their feet and provides them with many years of active life. To avoid this, gymnastics and physical therapy are recommended for dysplasia.

Timely diagnosis of the disease and proper physical activity for hip dysplasia in children can save the child from a wheelchair in the future.

Nowadays, many methods of rehabilitation after prosthetics have been created. Physical therapy is widely used, taking into account the characteristics of all postoperative periods. Basically, three periods are defined for people who have undergone endoprosthetics. The first period lasts from the moment of surgery until 10 days after it.

The goals of this period include:

• promoting emotional upliftment in the patient;
• prevention of complications in the respiratory and cardiovascular systems;
• improving blood circulation in the legs;
• increased mobility in the endoprosthesis;
• teaching the patient how to handle the prosthesis (sit down, turn, perform exercises, etc. correctly).

The second period lasts from 10 days to 3 months. Goals of the second period:

• strengthening the muscles of both legs;
• complicated workouts - going up and down stairs;
• resumption of correct gait.

• continued strengthening and training of leg muscles;
• getting used to stress and physical activity, both everyday and work.

For each of the listed periods, there are a number of therapeutic exercises and physical education.

Approximate set of exercises

In the first period after prosthetics, the leg is fixed, but periodically the position of the operated leg needs to be changed. Used to secure the leg in the correct position with a bolster or cushion. If you need to change your body position, the pillow must be placed between the thighs to prevent the leg from making unwanted movements. During this period, it is recommended to warm up both legs. A healthy leg makes movements in all joints.

The operated leg requires more careful movements:

• move your foot back and forth until tension appears in the muscles;
• tense and relax the muscles of the thighs and buttocks;
• using a pillow to raise your leg at the knee, move your leg up;
• move your legs along the bed to the side and back;
• leaving your pelvis motionless, lift your leg up.

In the second postoperative period, short walks using a cane are carried out several times a day. Each time they become longer and more intense. Rest should preferably be lying on your back. You need to get dressed while sitting on a chair, with your knees below the level of your pelvis. For a prosthetic leg, you can perform exercises on your back:

• bend and straighten the ankle and rotate the foot;
• keeping your feet firmly on the floor, bend your knees;
• spread your legs apart along the floor;
• make a bicycle.

Abdominal exercises are also shown:

• bend your legs, reaching your heels to your buttocks;
• straining your gluteal muscles, try to lift your straight leg;
• Perform crawling movements “on the belly”.

Chair exercise:

• placing emphasis on the knee of the healthy leg and palms, lift the operated leg forward, backward and to the side; at the same time, the lower back does not bend, the pelvis is motionless.

In the last treatment period, gymnastics are performed in the same way as in the second, only the load is increased. Half squats with support are added to the exercises, and later without it. In this case, the pelvis does not bend more than 90 degrees, and the knee does not move far forward. Dysplasia is common in children. The basis of this disease is a disorder associated with the development of the osteochondral structure of the joint, its ligaments and muscles. It is often diagnosed in the hip joint in newborns. The peculiarity of dysplasia is that in the absence, insufficiency or incorrectness of treatment, the child almost always develops a disability.

Hip replacement and rehabilitation are indivisible

Until recently, diseases of the musculoskeletal system and diagnoses of arthrosis and coxarthrosis were terrifying; the percentage of complete disability and loss of independent movement reached incredibly high levels.

Today, such pathologies are not a hopeless situation: the latest technologies in prosthetics make it possible to completely eliminate the disease and return a person to a full life.

One of these modern technologies is total hip arthroplasty (THA). The essence of the operation is the complete replacement of the affected area with an implant. This manipulation allows you to completely eliminate pain and restore motor activity.

Against the background of the effectiveness of prosthetics, postoperative recovery should also be taken into account. What result will be obtained, how well the prosthesis will take root, depends not only on the qualifications of the orthopedic surgeon, or how well the arthroplasty was performed, but also on the further actions of the patient.

Further actions are rehabilitation after surgery. Not all doctors in the CIS countries, Russia or Ukraine fully understand the importance of such an event. If you go to any forum for patients after this treatment, you can find reviews that the surgeon’s advice was to increase walking. The most important point is missed - an integrated approach to recovery.

Even the most expensive prosthesis and surgery in the most famous clinic will not give the desired result without properly developed rehabilitation. Its absence leads to the resumption of pain in the joint, the development of lameness and other pathological processes. As a result, after 5 years, or even earlier, the patient is prescribed a revision - repeated - intervention.

It will not be possible to undergo complete rehabilitation and return to your normal lifestyle in a couple of weeks. Recovery takes quite a long time, but with the right approach and patient patience, restoration of motor activity can be fully guaranteed.

The whole process is complex and should begin on the 1st day after surgery. The basis is exercise therapy - physical therapy, which allows you to strengthen the muscles of the lower extremities and normalize the functioning of the new joint. Additionally, other methods of physical treatment are used, which will speed up recovery and improve its results. In most cases, patients prefer to go to a rehabilitation center, where, under the supervision of specialists, it is possible to achieve high therapeutic results.

In the first two to three weeks after hip replacement, experts advise conducting classes under the supervision of a rehabilitation specialist in the orthopedic department of a hospital or in a specialized center.

Prevention of thrombosis remains an important point, especially for elderly patients. This group of patients has a high risk of developing blood clots during surgery, which, if they break off and enter the pulmonary artery, can cause instant death.

To avoid complications, in the first two days the operated leg is fixed with an elastic bandage and a course of antiplatelet medications is prescribed.

Stage-by-stage features of recovery

Aspects of successful recovery

For successful recovery, you should adhere to the following rules and recommendations:

• take the trouble to forget about your laziness, otherwise not a single rehabilitation center will bring success in treatment;
• The first restoration measures should be carried out a day or two after the operation. The load is minimal and uncomplicated, the exercises are relatively passive;
• Regularity and an integrated approach are important. Perform exercises daily, alternating loads on different muscle groups;
• perform all exercises daily, regardless of your general condition. There should be loads every day, even the most insignificant ones.

Lack of rehabilitation leads to severe pathological processes and complications. During the operation, an incision is made into the muscle, it is injured, loses elasticity and tone, there is a risk of scar tissue forming, and the muscles remain in a stretched position. Such processes lead to the following:

• dislocation of the implant head;
• inflammatory process in the nerve structure, development of neuropathy.

An important point is the early recovery stage. Doctors often do not pay due attention to this, and all medical procedures are limited to caring for the postoperative suture and monitoring the general condition of the patient.

The goals of the early rehabilitation period are:

• in creating favorable conditions for the formation of new blood vessels feeding the joint;
• in minimizing the risk of complications and the need for revision surgery;
• in teaching the patient how to walk correctly, perform exercises, etc.

Today, videos of Bubnovsky’s restoration are popular among those who have undergone hip replacement, and there are also positive reviews among patients in Moscow and St. Petersburg.

What to do on the first day?

Recovery procedures should begin on the first day after surgery; if this is not possible, reschedule the next day. First steps:

• move your toes every 15-20 minutes;
• bend and straighten your fingers every hour - 10-12 times every 60 minutes;
• the legs are extended, the toes are pointing upward, the foot is pulled towards itself one by one - 5-10 times every 30-40 minutes.

The duration of the period is determined by the attending physician individually. If the patient complies with all the instructions, completes the assigned tasks and the results are visible, the next stages of rehabilitation can begin.

The second stage begins from 5-10 days and lasts 3-4 weeks. Since the operation allows pain to be relieved, patients’ well-being improves significantly and they feel a surge of strength. This phase is often called “deceptive possibilities”: having felt improvement, patients themselves move on to loads that are an order of magnitude more difficult than permitted. Many rule out the use of a walker or cane, which is strictly prohibited.

An increase in loads is recommended at the third stage - 4-10 weeks, after complete adaptation of the implanted prosthesis. At this stage, it is possible to recover at home using an elastic band or other devices, introducing loads using exercise bikes and walking.

The result of recovery depends not only on a professionally performed operation. The outcome of arthroplasty depends on rehabilitation and how responsibly the patient approaches it.

What can you do after hip replacement?

The new hip joint is an analogue of the “native” one. Naturally, its functional and anatomical capabilities coincide, but it is not a blood biological element. In order for the “new” joint to take root and not be at odds with the physiological capabilities of the bones and skeleton, it takes time, a competent approach to rehabilitation, and purposefulness on the part of the patient.

More details

Hip implantation is a serious surgical procedure that requires the patient to comply with a number of rules. The period after surgery is not only about restrictions: many things are accessible and solvable.

What can you do after replacing the hip joint? Let's look at frequently asked questions.

From what day is it allowed to sleep on your side?

Gently lying down on the operated leg is allowed after 6 weeks - not earlier. A cushion or hard pillow is placed between the legs.

Is it possible to visit a bathhouse or sauna after hip replacement?

It is allowed to visit the sauna or take a steam bath, but not earlier than 6 months after the installation of the prosthesis. Please note: the time spent in the steam room must be reduced. Even when implanting a titanium joint, overheating it is not recommended.

When can you bend over and use stairs?

During the first month, climbing stairs should be done with additional assistance. Crutches or a cane will do. After 6-8 weeks you can move independently and bend over.

Recovery time is purely individual. All further actions must be discussed with the attending physician in order to avoid complications and other unpleasant processes.

Treatment of joints Read more >>

Life a month after endoprosthetics

Four weeks after replacing the original joint with an implant, the late phase of rehabilitation begins. Duration is 10-12 weeks, but depends on the age of the patient and his general condition.

The main task of the stage:

• strengthening muscles, increasing muscle tone through regular training;
• increasing the range of motion in the joint;
• introduction of new physical exercises - exercise machines, swimming pool, climbing/descending stairs.

After 2 months of rehabilitation, training becomes more complex, physical activity and activity increase. If recovery is successful, the patient at this stage should completely abandon walkers or crutches and switch to a cane. Training also remains daily, with an additional exercise for knee flexion and extension with resistance. You can perform slow side leg raises with similar resistance.

The stage after 6-8 months or more is considered a late period. It is necessary to undergo a full course of recovery in specialized centers - sanatoriums, hospitals, in order to recover after surgery and minimize side effects. When visiting a sanatorium, it is recommended to opt for the following procedures:

• therapeutic massage to restore blood circulation in the thigh;
• the use of alternative medicine - acupuncture (improves tissue trophism, relieves spasms);
• physiotherapy - ultraviolet, laser, exposure to current of various frequencies;
• water activities - water aerobics, therapeutic baths.

It is possible to increase the complexity of physical activity and introduce more complex training after 8-14 weeks after surgery. Any innovations must be implemented under the guidance of the attending physician, otherwise the risk of complications and reoperation will increase. On average, the rehabilitation period lasts about a year. The patient independently conducts exercise therapy sessions at home and monitors his health.

A hip dislocation is a separation of the acetabulum and the articular end of the femur. Pathology occurs as a result of injury (both in children and adults), due to disturbances in the development of the joint, and can also be congenital.

Kinds

Such dislocations are classified based on the nature of their origin:

• Traumatic
  Develops due to direct impact on the joint (impact, pressure). As a rule, such a dislocation is accompanied by ruptures inside the joint capsule. The condition can be complicated by tissue entrapment and bone fractures.
• Pathological
  Most often, pathological dislocation of the hip joint is the result of joint inflammation.
• Congenital
  Associated with developmental pathologies that occur during intrauterine development. Congenital dislocation is diagnosed in newborns and children under 1 year of age.

Injuries are also divided into types:

• posterior dislocation
  This dislocation is characterized by damage to the head of the femur, which extends backward and upward relative to the joint. This type of injury can often occur in car accidents.
• anterior dislocation
  When an injury occurs, the joint capsule ruptures and the head of the bone moves forward with a downward displacement. A similar injury occurs when falling on a limb rotated outward.
• central dislocation
  A very serious injury, characterized by protrusion of the head of the bone and retraction of the great nerve. With this type of dislocation, the acetabulum is destroyed.

In this article we talk about all the possible causes of pain in the hip joint.
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Symptoms

General symptoms and photos of hip dislocation:

• sharp, severe pain;
• forced unnatural position of the leg;
• shortening of the leg (on the side of the disorder);
• joint deformity;
• significant motor restrictions.

With an anterior dislocation, there is a slight flexion of the limb at the joint and abduction to the side, the knee facing outward.

With a posterior dislocation, the knee is directed inward, the limb is bent at the hip joint, and brought toward the body. Shortening of the leg on the side of the injury is often noted.

Central dislocation is characterized by severe pain, joint deformation, and shortening of the leg. The knee can be slightly turned both outward and inward.

Diagnostics, photo

In order to confirm the presence of this injury, a consultation with a traumatologist is necessary. He examines the patient, palpates the damaged area, and studies the symptoms.

Each patient, without exception, needs to have an x-ray taken in the anterior and lateral projections. This method allows you to find out the exact location of the head of the bone and determine the probable tissue damage.

CT and MRI are performed when radiography does not provide the necessary information to confirm the diagnosis.

Help

Should I call an ambulance?

The arriving ambulance team will take the person to the nearest hospital, where, using general anesthesia, the dislocation will be reduced.

Independently adjusting a joint is an action that, as a rule, does not bring results. The fact is that there are powerful muscles around the joint, which, when injured, become very tense. Muscles can only be weakened using anesthesia. In addition, incorrect actions increase the risk of serious complications, especially if a femoral neck fracture or damage to large vessels and nerves occurs.

What can be done?

1. The first step is to give the patient some kind of painkiller. The most effective is to inject analgesics into the muscle. You can use the following pain medications: Analgin; Tramal
2. Next, it is very important to perform immobilization, that is, to fix the affected limb. For these purposes, you can use sticks and iron rods (it is important to first wrap the objects with a bandage). Another fixation option is a method in which the damaged limb is tied to a healthy one.
3. When immobilizing, it is necessary to fix the leg in exactly the position it took after the dislocation. It is strictly prohibited to bend, straighten, or rotate the limb!
4. After fixing the leg, it is necessary to apply cold to it. An ice pack and a cloth moistened with cold water can be used for this.

Treatment in adults

Reduction according to Dzhanilidze

Reduction of a dislocated joint in adults using these methods is carried out as follows:

1. after introducing the patient into deep anesthesia, he is placed on the table face down so that the affected limb hangs freely;
2. two bags filled with sand are placed under the person’s pelvis;
3. the doctor's assistant presses on the patient's sacrum, fixing it;
4. the surgeon bends the patient’s leg at the knee and places his knee in his popliteal fossa;
5. By persistently pressing with the knee, the specialist turns the injured leg outward.

Kocher reduction

When the first method does not produce positive results, they resort to the Kocher reduction method, which is carried out exclusively in adults in the following order:

1. the patient is put under anesthesia and placed face up on the table;
2. the patient's pelvis is securely fixed by the doctor's assistant;
3. the surgeon bends the leg at the knee and hip, makes several sharp circular movements of the patient’s affected leg, due to which the natural position of the joint is restored.

The described treatment methods are not suitable for children!

After reduction

After the manipulation is completed, a splint is applied to the patient in such a way as to fix the hip, knee and ankle joints.
It happens that after reduction, it is necessary to apply skeletal traction. This is done as follows:

1. After the patient is put under anesthesia, a surgical wire is passed through the tibia, onto which a clamp with a weight is attached.
2. After reduction, strict bed rest is indicated for at least a month. After this period, the patient is allowed to walk using crutches for support, which must be used for a further 2-3 months.

Treatment of complicated hip dislocation

Complications of hip dislocations include:
impossibility of reduction using the Kocher or Dzhanilidze method. This happens when reduction is hindered by the articular capsule or tissue that is caught in the gap between the acetabulum and the head of the bone;
ligament rupture.

In such cases, surgical treatment is performed, during which the surgeon makes an incision that gives him access to the damaged joint. The doctor eliminates all abnormalities (tissue trapped in the joint, stitches the ligaments) and realigns the head of the bone.

Operation

To treat an old dislocation, two types of operations are used:

• Open reduction, which can only be carried out when the articular surfaces are preserved. Arthrodesis is the fixation of a joint whose changes are irreversible and whose functions are completely lost. After such a surgical intervention, the patient can rely on the injured limb.
• Endoprosthetics

A treatment method in which a damaged joint is replaced with an artificial one that fully matches the structure of a healthy joint.
The selection of an endoprosthesis is made individually and depends on the following parameters:

• general health of the patient;
• age;
• Lifestyle.

The goal of endoprosthetics is to reduce pain in the joint and restore its functionality. The service life of the endoprosthesis is up to 20 years, after which it is replaced.

Treatment of newborns, children

To treat children with hip dislocation (congenital or traumatic), both conservative and surgical treatment are used. Most often, surgical intervention is not performed in newborns, however, in case of complex congenital dislocation, the baby is indicated for just such treatment.

As a treatment for children, a splint is used to fix the newborn’s legs in a position in which they are bent at the knee and hip joints at an angle of 90° or abducted at the joints. This helps the correct formation of joints in the future. The reduction is carried out smoothly, gradually, avoiding the possibility of injury. It is unacceptable to make significant efforts when carrying out the procedure for newborn children.

Experts advise using wide swaddling for the newborn and performing therapeutic exercises.

Consequences of a dislocated joint

The consequences of this pathology can be very dangerous. Among them, the greatest health risks are:

• disruption of large vessels, which can cause necrosis of the femoral head and tissue destruction.
• bruise of the sciatic nerve, which causes sensory disturbances, movement disorders, and severe pain;
• compression of the femoral vessels, resulting in poor circulation in the legs;
• disruption of the obturator nerve, resulting in muscle disorders.

Due to the likelihood of complications from hip dislocation, especially in children and newborns, you should consult a doctor.

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Rehabilitation

After a dislocation, the patient must undergo a long course of comprehensive rehabilitation, which includes:
Massage.
During the first sessions, massage is a gentle treatment in the form of rubbing and stroking, which is aimed at restoring blood flow at the site of injury. Subsequent sessions become more intense, kneading techniques are used;
Exercise therapy.
At the initial stage, exercise therapy is aimed at maintaining normal blood circulation in the muscles, in order to avoid their atrophy. Next, include exercises aimed at maintaining joint mobility (flexion/extension, adduction/abduction). At the last stage of physical therapy, exercises are performed to restore joint function.

Physiotherapy

Physiotherapeutic treatments include:

• magnetic therapy;
• exposure to diadynamic currents;
• exposure to heat, etc.

The treatment program is developed individually.
Spa treatment

During the recovery period after a dislocation of the hip joint, patients are recommended to undergo treatment in a sanatorium-resort setting:

• Sanatorium "Raduga", Republic of Bashkortostan, Ufa, Aurora st., 14/1.
• Sanatorium "Oren-Crimea", Russia, Republic of Crimea, Evpatoria, Frunze St., 17.
• Sanatorium “Lunevo”, Russia, Kostroma region, Kostroma district, p/o Sukhonogovo, village Lunevo

Dislocation after endoprosthetics

There are many reasons why the endoprosthesis head dislocates. The most common are:

• advanced age of the patient;
• muscle weakness;
• joint inflammation;
• history of neurology;
• inappropriate size of parts of the endoprosthesis (or the entire endoprosthesis);
• unhealthy lifestyle (smoking, alcoholism, drug abuse), etc.

Most often, dislocation after endoprosthetics occurs when the tissues have not yet fully strengthened and recovered. Such dislocations are reduced using the closed method, using anesthesia with muscle relaxants, after which conservative treatment is carried out.

Repeated dislocations of the endoprosthesis are adjusted openly. It happens that some parts of the endoprosthesis require replacement.

Pain after dislocation

If after repositioning the patient continues to experience pain, you can use painkillers such as Ibuprofen, Analgin, Tempalgin, etc. Such drugs help eliminate the pain symptom, but, nevertheless, for their correct use, consultation with the attending physician is necessary.

There are traditional methods for relieving pain after a sprain.

So, ordinary lard, which is applied as a thin plate to the joint area, will help reduce pain. Once the lard is depleted, it must be replaced with new one.

Another remedy for pain is mustard ointment. To prepare it, you need to mix 50 g of salt, 25 g of mustard and a little kerosene. The mixture should acquire a creamy consistency; it should be used at night, rubbing into the sore spot.

Prevention

The main preventive measures are:

• maintaining a healthy lifestyle;
• playing sports (to develop and maintain joint flexibility);
• consult a doctor in a timely manner if any symptoms occur;
• strict adherence to the doctor’s instructions if a newborn is diagnosed with congenital dislocation.