Knee prosthesis. Materials used in hip arthroplasty Materials of the components of the endoprosthesis

Endoprosthetics of the hip joint is a surgical operation that is performed with a pronounced violation of its work: with injuries, as well as with its high wear and tear. Who needs hip replacement surgery? How much does this operation cost? How is this surgery done? We will consider all these questions below.

Indications for hip replacement surgery
- Myth #1: Hip surgery should only be done as a last resort.
- Myth two: for a full recovery, you just need to do this operation
- Myth three: the endoprosthesis quickly fails
- Replacement of surfaces of the hip joint
- Partial arthroplasty
- Total or complete dentures
- Varieties of prostheses

Contraindications for the operation
How to continue to live after prosthetics?

Indications for hip replacement surgery

Hip arthroplasty or joint replacement surgery is usually performed for conditions and pathologies such as:

aseptic necrosis of the bone head of the femur;
fracture of the bone neck of the femur;
osteoarthritis of the hip joint;
consequences of traumatic injuries;
hip dysplasia.

All of the above diseases are not yet a mandatory indication for surgery: in each individual case, this issue is resolved after a thorough examination and examination of the patient by a doctor.

As for arthrosis of the hip joint, surgery is usually performed at advanced stages of the disease (at stage 2-3 of the disease), as well as with severe and persistent pain in the joint, even at rest, with withdrawals, which painkillers can no longer cope.

Myths about hip replacements

There are popular misconceptions about hip replacement surgery, due to which most patients have a negative attitude towards surgical interventions or evaluate them incorrectly. Will try to dispel these myths.

Myth #1: Hip surgery should only be done as a last resort.

Most people who suffer from coxarthrosis or arthrosis of the hip joint postpone the implementation of prosthetics until the last moment, intending to do it only when the ability to walk is completely gone. In fact, this is not the best tactic. Postponing the visit to the doctor, this person will absolutely in vain continue to experience pain in the joint, which it would be quite possible to prevent by performing an operation earlier.

In addition, if a patient with this disease is not in a hurry for a hip replacement surgery (which has been required for a long time), then by this delay he only aggravates the course of the disease. At this time, the disease continues to adversely affect the patient's health and only begins to intensify every day, thereby lengthening the recovery time and returning to a full life.

Myth two: for a full recovery, you just need to do this operation

In reality, this is absolutely not the case. Coxarthrosis or another disease, due to which this operation must be performed, is a pathology not only of the hip bone, but also of the entire joint and even, in general, of the body.

Due to the fact that a person spares the affected leg and uses the ligaments of the joint less, the thigh muscles atrophy, weaken, the density of bone tissue decreases (that is, osteoporosis appears).

Therefore, for a complete recovery, an integrated approach is needed, when after the operation a correctly chosen rehabilitation program, physiotherapy, physiotherapy exercises and other methods of treatment follow, which can help a person get back on his feet faster and feel healthy again.

Myth three: the endoprosthesis quickly fails

This also does not always correspond to reality. Since hip replacement is a rather complicated operation, all prostheses are made with the expectation of maximum performance and durability.

Prostheses are made of high-quality metal, ceramics or plastic, due to which the life of the endoprosthesis is more than 25 years, and if everything is fine, then only after this time has passed, a second operation is performed to replace the prosthesis. And in older people, due to this long time of operation of the prosthesis, there is often no need for repeated surgical intervention.

Varieties of endoprosthetics

There are three types of hip replacement surgery performed today:

replacement of surfaces of the hip joint;
installation of a total or complete endoprosthesis;
installation of a partial endoprosthesis.

Replacement of surfaces of the hip joint

With this type of operation, the surgical impact directly on the joint is minimal (unlike other methods). The cartilaginous layer is removed from the acetabulum of the hip bone, and an artificial articular bed is placed instead.

As for the hip bone, its head is turned in a special way, then a special cap made of high quality material is put on it. Due to these changes, the bone surfaces of the joint are changed to artificial ones, while sliding between these parts becomes as close as possible to the ideal state.

Partial arthroplasty

This surgical intervention affects more tissues, but the operation is performed at more advanced stages of the disease, when the process of replacing the surfaces of the joint is no longer quite reliable.

With this type of surgical intervention, the bone head of the femur is no longer turned, but removed completely. In addition, the bone neck of the femur is also partially removed, and instead of the removed tissues, an artificial articular bed is placed, as well as an artificial bone head of the femur with a ceramic or metal joint surface. A special pin is inserted into the body of the bone, and due to this, the design has excellent strength.

Total or complete dentures

Total hip replacement is the most radical operation of all of the above, but at the same time the most effective. Its meaning is that during it a complete replacement of the femoral joint takes place. The remnants of cartilage tissue are removed from the pelvic bone, and a new - metal or ceramic - joint bed is placed in its place.

The second part of the artificial prosthesis consists of an iron pin of increased strength, which is made of stainless steel, titanium or other metals, and a joint head, which can also be made of high-quality ceramics or metal. A metal pin is inserted into the femur bone and fixed there, ensuring the stability and reliability of the entire structure, and the endoprosthesis head is fixed directly to it.

Varieties of prostheses

Since all people are different, with different builds and sizes, all the elements of this artificial prosthesis - the articular bed, the head of the joint, the pin - are selected individually for each person separately.

There are more than 200 different components of this endoprosthesis. Their choice is made by the surgeon during the examination of the person and his preparation for this surgical intervention.

In addition, dentures are made from various materials:

ceramics;
metal;
high quality polyethylene;
plastic.

Taking into account which person, with what lifestyle, and what age the prosthetics operation is performed, these materials can be combined with each other in different combinations.

Thus, for an elderly person who has little physical activity on his leg, endoprostheses can be installed, where one articular part - for example, the joint bed - is made of plastic, and the second is made of ceramics. This combination makes it possible to significantly increase the life of the prosthesis.

And when the operation is performed on a young patient whose joints have had (and will continue to experience) rather large physical loads, the strategy for choosing an endoprosthesis will be completely different. This person, as a rule, is fitted with a prosthesis, where both surfaces of the joint are made of metal, or both elements are made of ceramics. These hip endoprostheses are more rigid, but at the same time they can serve for a longer time, even with very significant physical exertion.

The cost of hip replacement consists of two components: the price of the prosthesis itself and the price of the operation simultaneously with inpatient treatment.

The cost of the prosthesis may differ depending on the type of disease: thus, a prosthesis for the surgical treatment of coxarthrosis may be more expensive than an endoprosthesis, which is necessary, for example, for fractures of the femoral neck and other diseases.

In general, the cost of a joint endoprosthesis can vary within 45-130 thousand rubles and more (approximately in Moscow at the beginning of 2016). The price of the operation itself simultaneously with treatment in a hospital, the rehabilitation process, etc. can be from 40 thousand rubles. for a fairly simple unipolar hip replacement, up to 450 thousand rubles. and more for complete prosthetics.

That is, the price of an all-inclusive operation (we are considering total prosthetics) can be from 50,000 to 500,000 rubles - during this surgical treatment in hospitals and clinics in Moscow.

When you do not trust Russian specialists much, you can perform this surgical operation in medical institutions of other countries - in Germany (18-25 thousand euros), Israel (16-21 thousand euros) or Turkey (11-16 thousand euros). ). But before performing this operation, you need to get advice from an experienced and competent orthopedic doctor, and sometimes more than one.

The duration of the operation is usually 40 minutes. up to 4 hours. Taking into account what specific arthroplasty is performed - partial or total - the duration of the procedure may also vary. The operation takes place both under spinal anesthesia and under general anesthesia.

In order for a person to begin to fully use the joint as quickly as possible, already on the 2-3rd day after surgery, very light physical therapy exercises for the joint begin to be performed, which over time complicate and increase the load on the sore leg. Most often, the next day after the operation, the person will already be able to sit on the bed.

As a rule, 10-12 days after the prosthetics, if everything happened without complications, the person is discharged from the hospital. By this time, he can already get out of bed and carefully begin to walk, and can also climb stairs with the help of crutches.

Contraindications for the operation

During the time of need for hip replacement, certain comorbidities may make surgery impossible. We are talking about people who have diabetes, Parkinson's disease, have experienced a heart attack or stroke. Problems with the cardiovascular system can also lead to significant complications after a joint replacement is performed.

Surgical intervention can also be problematic in the case of pronounced muscle weakness in a person. It is necessary to take into account contraindications, since if they are present, the risk of dislocation or damage to the artificial joint increases. If the state of health of the human body can be defined as poor, and the chances of various complications are quite large, then there is a possibility that the operation will not be successfully performed.

How long a prosthesis will last will depend on many factors. The most common complication is loosening or displacement of the endoprosthesis. And there is a slight difference in the length of the legs.

Probably the appearance of blood clots in the blood vessels. In order to prevent the occurrence of this complication, treatment with anticoagulants is performed. The use of special stockings, exercises for the lower leg, periodic leg lifting are added to the treatment complex.

Infectious complications may also appear after surgery. To reduce this risk, antibiotic therapy is performed. Probably infection from other foci of a chronic inflammatory process.

Patients who do not follow the doctor's advice, and put a lot of stress on the hip joint, may increase the risk of fracture or dislocation of the implant. In overweight patients, this risk is increased. To prevent complications, you need to monitor your own weight and avoid significant loads.

In some cases, the bone that is next to the joint is destroyed. This happens as a result of the body's reaction to contact with a foreign body. It is likely that the elements of the prosthesis will need to be replaced or it will have to be removed due to a person’s allergic reactions to a foreign body, improper cementation, or improper installation of the prosthesis.

How to continue to live after prosthetics?

Naturally, an extract from the clinic does not mean that the treatment and rehabilitation period ends. The attending surgeon develops a complex of rehabilitation treatment for the patient, which consists of several stages, during which the patient, as it were, learns to walk again and use the new joint, learn to move and restore former loads.

Moreover, the return to normal life, for a patient with a full load, most often occurs after a few months - with the condition that he follows all the doctor's advice. In certain cases, including during the elderly age of the patient, the time for full restoration of joint functions can last up to 6 months.

How to choose the best hip replacement

Hip arthroplasty is often the only method for restoring motor activity. The installation of the implant eliminates the pain syndrome that does not leave the patient with diseases of the musculoskeletal system.

Modern types of prostheses are designed to completely imitate the native joint and fulfill its functional abilities.

From a large number of endoprostheses, you can choose a suitable implant. Sometimes patients try to choose an implant on their own, study brands, models, varieties. Orthopedists often hear the following from patients:

Recently I read (-la) that the most reliable prosthesis is made of ceramics.
A cemented denture is an obsolete model, while a cementless denture is a good option.
The best prostheses are foreign, they have positive reviews.

The first myth that should be dispelled is that there is no best endoprosthesis.

The second is that there are many variations of orthopedic constructions for replacing hips: some of them are better, others are inferior in one way, but superior in another. We are talking about well-known companies operating in the orthopedics market for more than a year.

There are inexpensive models, but there are also expensive prostheses. This does not mean that the cheaper option can be much worse and provoke complications. When releasing a new implant model, the company is forced to raise its cost, since development, production, and consumables require large investments. New models will take into account the shortcomings of the previous ones and will no longer contain them. It is possible that the service life will be longer.

In the third case, it is necessary to take into account not only the quality of the prosthesis, but also the work of the surgeon. Even an expensive implant does not guarantee the success of the operation with a low qualification of the doctor and no experience in arthroplasty. Therefore, it is worth focusing not only on models and firms, but also on the knowledge of the one who will operate on you. Don't forget the importance of rehabilitation. A full recovery course will guarantee a successful recovery with any type of prosthetic design.

Models of leading foreign firms do not have any particular differences, so it is difficult to say which one is better. Comparison - rather by the standards of price-quality. Well-known firms Zimmer, De-Puy, Biomet produce equivalent samples that do not have pronounced differences.

When choosing a prosthesis, look not at the company or cost, but at a more important feature that affects the life of the adaptation - a friction pair.

Types of endoprostheses, their differences

If we talk about the appearance of the prosthesis, it is a complete imitation of a person's native joint, which can withstand everyday stress and has the same functional abilities as the previously destroyed one.

Features and differences are distinguished by the type of arthroplasty:

superficial. The head of the hip joint and the acetabulum are replaced;
total. Complete replacement of damaged bone and cartilage with excision of the femoral neck.

Implants are distinguished by the method of attachment:

Fixation without medical cement. It is used for young patients without signs of osteoporosis. With good bone density, they grow into the prosthesis and secure it. With cementless fixation, a stem having a titanium alloy can be used.
Fastening with cement. The technique is used in the elderly or in patients whose bone density does not allow the use of a cementless method.

Recently, you can often hear the concept of "liquid implant". It is not related to full-fledged endoprosthetics, since it is not a prosthesis. It is supposed to introduce certain types of acids, the purpose of which is to restore the connective tissue of the cartilage. Any expert will tell you that this is impossible. Under the influence of the degenerative-dystrophic process, pathologies, the joint is completely destroyed and does not have the ability to regenerate. The only way out is surgery.

Consider friction pairs. It makes no sense to choose a particular brand or focus on price, but it makes sense to consider other characteristics, because wear products will negatively affect the surrounding soft tissues and bones. Here's what you really need to discuss with your doctor.

There are the following varieties:

metal combined with metal;
metal and polyethylene;
ceramics plus ceramics;
combination of ceramics and polyethylene.

Each type has its own advantages and disadvantages. It cannot be said that the combination of some components will be bad, and the other - good. The prosthesis, as well as friction pairs, are selected individually. What is not suitable for one patient may be recommended for another.

Variety	Positive sides	Negative sides
Combination of pottery and ceramics	Friction components are non-toxic High wear resistance Possibility to choose a large head diameter	High risk of material splitting during physical exertion Relatively high price Often causes squeaks
Metal combined with metal	Short service life Material stability, high mobility New models are released annually, more advanced (there is plenty to choose from)	low price High toxicity of friction products The cup is sensitive to inclinations, it is advisable not to exceed 50 degrees
Metal and polyethylene	Budget implant, the cost is more affordable The most popular type of friction pair In combination with a low price has a decent quality Cup angle tilt can reach 90 degrees	Less durable than other types Head diameter not available over 32mm There is some toxicity, although quite moderate
Ceramics and polyethylene	The best prosthesis. Suitable for everyone without exception, although it is recommended for older people with a passive lifestyle	Service life is quite long

A popular option - a combination of a metal component with a metal one due to its low price, however, is not recommended for installation for everyone - it has a number of limitations. It is more often implanted in men who are accustomed to a more active lifestyle. It is strongly not recommended for women planning future pregnancy: there is a high risk of penetration of toxic products into the placenta, which negatively affects the fetus. In a number of countries, the use of such a combination of components is prohibited.

More often used ceramics in combination with polyethylene: suitable for patients of any category, has no age restrictions. Revision replacement intervention may be needed after 15-20 years.

From 10 to 15% of complications after arthroplasty are associated with incorrect selection of the prosthesis, and more specifically, friction pairs. That is why it is important to find a qualified orthopedist and pay attention not to the brand of the implant, but to its quality.

The highest service life of the friction pair "ceramics plus ceramics". Suitable for almost all patients, the only contraindication is that such prostheses for osteoporosis (low tissue density) are not implanted. The main condition that allows you to extend the duration of use, reduce the risk of reoperation is the correct installation of the structural components.

Hip joint: prosthesis price

The cost of endoprosthetics and the implant itself depends on the medical center of orthopedic surgery. The average price in Moscow according to 2014 statistics is 90,000-120,000 rubles. This price did not include hospital stay and diagnostic tests.

The price of orthopedic structures depends on the manufacturer and the material used. Foreign companies offer implants in the region of 1300-2000 dollars, domestic ones are several times cheaper.

The quality of arthroplasty is not affected by the cost, but by the quality of the operation and subsequent rehabilitation. Even the most expensive endoprosthesis does not guarantee a therapeutic effect if the intervention is performed incorrectly and there is no correct recovery period.

Where to buy a hip prosthesis?

You will deal with the purchase of an implant to replace the hip joint directly with your doctor. It is they who cooperate with manufacturers and will be able to say how much a certain type costs.

The prosthesis can be bought independently in a specialized store or ordered via the Internet. The service is possible provided that you have agreed in advance all the nuances, found out the required type of prosthesis.

In the cities of Russia there are companies - official distributors of foreign manufacturers of orthopedic implants. More often you can hear about "Legacy MED" (works with the world famous American company "Johnson & Johnson"). Here you can buy titanium and ceramic endoprosthesis. The consultant will tell you the exact price.

Dislocation of the hip prosthesis

The development of such a pathology as hip dislocation after replacement is a rare case; it is diagnosed no more than 2-4 times per 100 operated patients. Symptoms are indistinguishable from dislocation to replacement. The clinical picture is as follows:

the development of a pain syndrome that is not amenable to relief with painkillers;
change in the length of the lower limb, its shortening;
violation of the amplitude of movement, stiffness, a sharp decrease in physical activity.

To clarify the stability of the design, the patient is introduced into a state of anesthesia, where the doctor deliberately subluxes the prosthesis, then sets it back to its original position. This procedure allows us to assume the causes that provoked the complication, and in the future to reduce the risk of re-dislocation.

The treatment consists in the reduction of the dislocation and the subsequent wearing of a special prosthesis, a course of physiotherapy exercises, physiotherapy, and massage.

Zimmer: hip prostheses

A well-known manufacturer of orthopedic equipment, a company founded in the USA over a hundred years ago - Zimmer (Zimmer). Throughout the entire period of its existence, the company has been constantly developing, introducing the latest technologies, creating new designs, prostheses. Its products are transported to different countries of the world, used in medical centers in Israel, Germany, Russia, and the Czech Republic.

Such popularity is associated with the quality of products: it is distinguished by durability and high adaptive capabilities.

The range of the company is wide, it is possible to choose a prosthesis in the price-quality ratio. Even inexpensive implants allow you to completely imitate the native joint and have good wear resistance.

What prosthesis can be purchased, how long does it last? Zimmer manufactures the following implant structures:

knee replacement prosthesis. The undisputed leader: almost half of the operations are performed with the use of prostheses from this company. Service life - 15 and more years;
endoprostheses for replacement of the shoulder joint. Unique innovative development - a joint with a maximum level of implantability, restoring hand functions by 95%;
implants for hip replacement. Large selection of species, there is the possibility of individual selection, including the price.

The main difference between Zimmer products is the high adaptation of the prosthesis, which shortens the rehabilitation period.

According to statistics, the artificial joints of this manufacturer in 99% of cases remain stable for 10-12 years after installation. In almost 85%, the Zimmer's lifespan is approaching 15-18 years. Therefore, such popularity of the company is quite justified.

Patients often ask the following question: is it possible to put our prostheses, how many years will they last? The quality of domestic manufacturers is not much worse, there are many worthy orthopedic companies. When answering another question, there are many factors to consider. Here everything depends no longer on the price of the implant, but on the chosen design - a friction pair, the skillful hands of a doctor and a rehabilitologist.

cost of the hip joint

Rarely, complications develop after joint replacement surgery; in 10% they are associated with an incorrectly selected implant. Patients are diagnosed with a fracture of the neck, the development of an infectious process, edema, hematoma.

Fact: there is no specific prosthesis - a universal model that could fit everyone and not provoke side effects.

The main mistake of many patients is to make a choice of an endoprosthesis design based on reviews from the Internet and on price. A person chooses the most expensive foreign-made prosthesis and performs the operation with a surgeon with little experience. As a result, adaptation is poor, recovery is long, and there are many complications.

If you decide on arthroplasty, pay attention - the price of an implant, Zimmer or ceramic, has nothing to do with the success of the treatment. It makes sense to opt for an inexpensive but suitable orthopedic item for you.

An experienced surgeon has his own preferences in models and brands, so a preliminary consultation and selection is essential. Experts, both private institutions and public medical centers, are more likely to advise choosing Zimmer and DePuy. Although the prostheses of these manufacturers do not have a fundamental difference, they are completely similar in appearance, these are high-quality products with the ability to choose a design taking into account financial capabilities.

Joint treatment More >>

How much does treatment with such endoprostheses cost? The average price in Moscow is 200,000 rubles, taking into account a stay in a private clinic, laboratory tests, a hospital and subsequent rehabilitation under the supervision of a specialized doctor.

There is an important point in orthopedic surgery: the basis of a successful recovery is recovery. Not one, even the most expensive, prosthesis guarantees the success of the operation without following the rules of rehabilitation.

In practice, there are enough examples when patients, acquiring the most innovative and expensive implant, completely ignored the restoration, believing that it was not needed due to the high price. The result - patients returned after a few years to the doctor with complaints of pain, swelling, development of lameness. In this case, there can be no conservative treatment - a revision surgery is prescribed, followed by additional costs and long-term rehabilitation.

Very often, replacing a native joint with an artificial one is the only way to restore the normal functioning of the musculoskeletal system. Approach responsibly to the choice of prosthesis, diagnosis, clinic, doctor and further recovery.

The first myth that should be dispelled is that there is no best endoprosthesis.

Models of leading foreign firms do not have any particular differences, so it is difficult to say which one is better. Comparison - rather by the standards of price-quality. Well-known firms Zimmer, De-Puy, Biomet produce equivalent samples that do not have pronounced differences.

superficial. The head of the hip joint and the acetabulum are replaced;
total. Complete replacement of damaged bone and cartilage with excision of the femoral neck.

Fixation without medical cement. It is used for young patients without signs of osteoporosis. With good bone density, they grow into the prosthesis and secure it. With cementless fixation, a stem having a titanium alloy can be used.
Fastening with cement. The technique is used in the elderly or in patients whose bone density does not allow the use of a cementless method.

metal and polyethylene;
ceramics plus ceramics;

Variety	Positive sides	Negative sides
		Relatively high price Often causes squeaks
	Short service life	low price
Metal and polyethylene
Ceramics and polyethylene	The best prosthesis.

When is the operation performed?
Criterias of choice
Price of different brands

What does the price depend on?

Indications and restrictions

dysplasia;
congenital anomalies;
some types of tumors;
aseptic necrosis.

What to consider when buying?

1. Construction type.

3. Method of fixation.

Price overview

Modern types of prostheses are designed to completely imitate the native joint and fulfill its functional abilities.

A hip joint implant with a metal friction pair is used less and less in practice due to metal friction products.

Recently I read (-la) that the most reliable prosthesis is made of ceramics.
A cemented denture is an obsolete model, while a cementless denture is a good option.
The best prostheses are foreign, they have positive reviews.

First myth, which should be dispelled - there is no best endoprosthesis.

Second- There are many variations of orthopedic constructions for hip replacement: some of them are better, others are inferior in one way, but superior in another. We are talking about well-known companies operating in the orthopedics market for more than a year.

The most durable and expensive implant is with a ceramic friction pair. But this is not always the case: overweight and very active people do not need ceramics - they can crack under load.

This can crack ceramics.

In the third case it is necessary to take into account not only the quality of the prosthesis, but also the work of the surgeon. Even an expensive implant does not guarantee the success of the operation with a low qualification of the doctor and no experience in arthroplasty. Therefore, it is worth focusing not only on models and firms, but also on the knowledge of the one who will operate on you. Don't forget the importance of rehabilitation. A full recovery course will guarantee a successful recovery with any type of prosthetic design.

Models of leading foreign firms do not have any particular differences, so it is difficult to say which one is better. Comparison - rather by the standards of price-quality. Well-known firms Zimmer, De-Puy, Biomet produce equivalent samples that do not have pronounced differences.

The ceramic head destroyed the acetabular component.

Second photo of the destruction.

When choosing a prosthesis, look not at the company or cost, but at a more important feature that affects the life of the adaptation - a friction pair.

Types of endoprostheses, their differences

It's important to know! Doctors are shocked: “An effective and affordable remedy for joint pain exists ...” ...

Features and differences are distinguished by the type of arthroplasty:

superficial. The head of the hip joint and the acetabulum are replaced;
total. Complete replacement of damaged bone and cartilage with excision of the femoral neck.

An example of a Zimmer surface implant.

Implants are distinguished by the method of attachment:

Fixation without medical cement. It is used for young patients without signs of osteoporosis. With good bone density, they grow into the prosthesis and secure it. With cementless fixation, a stem having a titanium alloy can be used.
Fastening with cement. The technique is used in the elderly or in patients whose bone density does not allow the use of a cementless method.

Scheme of implant fixation methods.

Recently, you can often hear the concept of "liquid implant". It is not related to full-fledged endoprosthetics, since it is not a prosthesis. It is supposed to introduce certain types of acids, the purpose of which is to restore the connective tissue of the cartilage. Any expert will tell you that this is impossible. Under the influence of the degenerative-dystrophic process, pathologies, the joint is completely destroyed and does not have the ability to regenerate. The only way out is surgery.

Metal-polyethylene, polyethylene-ceramic, ceramic-ceramic.

There are the following varieties:

metal combined with metal;
metal and polyethylene;
ceramics plus ceramics;
combination of ceramics and polyethylene.

Variety	Positive sides	Negative sides
Combination of pottery and ceramics	Friction components are non-toxic High wear resistance Possibility to choose a large head diameter	High risk of material splitting during physical exertion Relatively high price Often causes squeaks
Metal combined with metal	Short service life Material stability, high mobility New models are released annually, more advanced (there is plenty to choose from)	low price High toxicity of friction products The cup is sensitive to inclinations, it is advisable not to exceed 50 degrees
Metal and polyethylene	Budget implant, the cost is more affordable The most popular type of friction pair In combination with a low price has a decent quality Cup angle tilt can reach 90 degrees	Less durable than other types Head diameter not available over 32mm There is some toxicity, although quite moderate
Ceramics and polyethylene	The best prosthesis. Suitable for everyone without exception, although it is recommended for older people with a passive lifestyle	Service life is quite long

Wear on metal components is visible to the naked eye.

More often used ceramics in combination with polyethylene: suitable for patients of any category, has no age restrictions. Revision replacement intervention may be needed after 15-20 years.

From 10 to 15% of complications after arthroplasty are associated with incorrect selection of the prosthesis, and more specifically, friction pairs. That is why it is important to find a qualified orthopedist and pay attention not to the brand of the implant, but to its quality.

Hip joint: prosthesis price

The price of orthopedic structures depends on the manufacturer and the material used. Foreign companies offer implants in the region of 1300-2000 dollars, domestic ones are several times cheaper.

Where to buy a hip prosthesis?

"Doctors hide the truth!"

Even “neglected” joint problems can be cured at home! Just don't forget to brush it once a day...

You will deal with the purchase of an implant to replace the hip joint directly with your doctor. It is they who cooperate with manufacturers and will be able to say how much a certain type costs.

In the cities of Russia there are companies - official distributors of foreign manufacturers of orthopedic implants. More often you can hear about "Legacy MED" (works with the world famous American company "Jonson & Jonson"). Here you can buy titanium and ceramic endoprosthesis. The consultant will tell you the exact price.

Dislocation of the hip prosthesis

the development of a pain syndrome that is not amenable to relief with painkillers;
change in the length of the lower limb, its shortening;
violation of the amplitude of movement, stiffness, a sharp decrease in physical activity.

The cause of dislocations is trauma, but strong muscles, hips, trained in the rehabilitation process, will help prevent this.

To clarify the stability of the design, the patient is introduced into a state of anesthesia, where the doctor deliberately subluxes the prosthesis, then sets it back to its original position. This procedure allows us to assume the causes that provoked the complication, and in the future to reduce the risk of re-dislocation.

The treatment consists in the reduction of the dislocation and the subsequent wearing of a special prosthesis, a course of physiotherapy exercises, physiotherapy, and massage.

Zimmer: hip prostheses

Such popularity is associated with the quality of products: it is distinguished by durability and high adaptive capabilities.

Zimmer is the "Mercedes" of endoprostheses.

What prosthesis can be purchased, how long does it last? Zimmer manufactures the following implant structures:

knee replacement prosthesis. The undisputed leader: almost half of the operations are performed with the use of prostheses from this company. Service life - 15 and more years;
endoprostheses for replacement of the shoulder joint. Unique innovative development - a joint with a maximum level of implantability, restoring hand functions by 95%;
implants for hip replacement. Large selection of species, there is the possibility of individual selection, including the price.

The main difference between Zimmer products is the high adaptation of the prosthesis, which shortens the rehabilitation period.

cost of the hip joint

Fact: there is no specific prosthesis - a universal model that could fit everyone and not provoke side effects.

If you decide on arthroplasty, pay attention - the price of an implant, Zimmer or ceramic, has nothing to do with the success of the treatment. It makes sense to opt for an inexpensive but suitable orthopedic item for you.

For the treatment and prevention of DISEASES OF THE JOINTS and SPINE, our readers use the method of fast and non-surgical treatment recommended by the leading rheumatologists of Russia, who decided to oppose pharmaceutical lawlessness and presented a medicine that REALLY TREATS! We got acquainted with this technique and decided to bring it to your attention. Read more…

How to forget about pain in the joints?

Joint pain limits your movement and life...
You are worried about discomfort, crunching and systematic pain ...
Perhaps you have tried a bunch of medicines, creams and ointments ...
But judging by the fact that you are reading these lines, they did not help you much ...

But orthopedist Valentin Dikul claims that there is a really effective remedy for joint pain!

Hip arthroplasty is a major orthopedic surgery to replace a damaged joint with an implant. The basis for surgical intervention is usually increased wear of the joint, as well as bruises and injuries in the area of the joints, which result in functional disorders. How much does arthroplasty cost and which is better to buy an implant? The advice and recommendations of orthopedic specialists will help you deal with the issue of choosing the optimal types of modern endoprostheses.

What affects the cost of an endoprosthesis?
When is the operation performed?
Criterias of choice
Price of different brands

What does the price depend on?

When planning to buy an implant for yourself, you should not be based only on the level of its cost. In fact, a large number of zeros on the price tag is not always a guarantee of a long and flawless endoprosthesis service. Its price depends on the type of model and the main diagnosis. For example, an implant for the surgical treatment of coxarthrosis is more expensive than a substitute needed for a hip fracture.

The combination of high cost with excellent quality in traumatology does not always look good. Since hip arthroplasty is considered a complex operation, the main thing is the high level of its performance, and not the high cost of the implant. A medical error can negatively affect even the highest quality material. It will be right if the patient entrusts the right to choose a prosthesis to a qualified surgeon. This is the main factor of successful arthroplasty. An experienced specialist will be able to decide which kind of artificial substitute is better to prefer in each case.

The most popular models of artificial joints are produced by international companies DePuy and Zimmer. In addition, Stryker, Smith & Nephew, Biomet, Aesculap, B. Braun are active participants in the modern market. Zimmer manufactures high quality Zimmer Trilogy cups. The DePuy brand is better known for the release of the Pinnacle line of endoprostheses. In terms of purpose and quality of performance, Zimmer and DePuy products are almost identical, so only a professional doctor can make a choice of the best option.

Indications and restrictions

An operation to implant an artificial organ is usually prescribed in the presence of certain types of diseases and negative conditions of HBS:

fracture of the femoral neck and the consequences of traumatic injuries;
coxarthrosis (deforming osteoarthritis) and other types of arthritis that caused degenerative-dystrophic changes;
dysplasia;
violation of the blood supply to the femoral head;
congenital anomalies;
some types of tumors;
aseptic necrosis.

The presence of any of the listed signs is not a mandatory indicator for surgical intervention. In each individual case, the issue of arthroplasty of the patient is decided by the attending physician after a thorough examination. In particular, with coxarthrosis, surgery is prescribed only at stages 2-3 of the disease. Also, the endoprosthesis is installed with unbearable prolonged pain in the hip joint, which do not respond to treatment for six months.

The following circumstances may serve as contraindications for joint replacement surgery with an endoprosthesis:

1. dermatological diseases and damage to the skin in the thigh area;

2. problems with peripheral vessels of the lower extremities;

3. quadriceps paralysis;

4. oncological diseases;

5. severe mental disorders;

6. overweight (more than 120 kg).

When deciding whether to install an endoprosthesis, the age and general health of the patient must be taken into account. Orthopedic surgery is not recommended for young people in cases where it is possible to maintain / restore function with the help of drug treatment.

What to consider when buying?

Externally, the artificial joint is very similar to the real one. In the classic version, it consists of a pin (leg), a cup and a head. The endoprosthesis takes on the usual physical activity and performs the same actions as a healthy organ. The operation to replace a damaged hip joint with an implant is called primary arthroplasty. When it comes to revision arthroplasty, it means the replacement of a previously installed joint.

On sale there are many varieties of prostheses, which are classified according to several criteria.

1. Construction type.

Unipolar - replacing the head of the hip joint.
Bipolar - prostheses that are installed instead of the femoral head and acetabulum. Such endoprosthesis is called total. It is often performed in orthopedics and traumatology.

2. Main material (cup and leg).

Metal and metal - a wear-resistant combination that can last at least two decades. Metal endoprostheses are best installed for men who lead an active lifestyle. Large joint heads allow for a wide range of motion. For women planning a pregnancy, prostheses are not recommended due to the high probability of penetration of metal ions into the fetus. The disadvantages include the high price of the endoprosthesis. In addition, as a result of friction of artificial surfaces, toxic products are formed. According to orthopedists, metal joints are rarely used in practice, and in some countries they are even prohibited.
Metal and plastic are an inexpensive option with moderate abrasion toxicity. The combination of materials is considered the most short-lived (10-15 years). Such a prosthesis can be purchased for people of an unsportsmanlike nature with a measured and calm lifestyle. Due to the low cost, implants are available to patients of retirement age.
Ceramics and ceramics - artificial joints are equally well suited to patients of any gender and age. They are durable and non-toxic. The main obstacle to the purchase of a ceramic endoprosthesis is the high cost. In addition, during movement, the implants can creak, which creates significant discomfort for patients.
Ceramics and plastic are the cheapest type of dentures. The combination is characterized by rapid wear and fragility, therefore it is more suitable for elderly patients of both sexes.

3. Method of fixation.

Cementless/mechanical - installation of endoprosthesis elements into the bone tissue by wedging or pressing. The joints are coated with a special compound. Thanks to this coating, the bone tissue “fuses” with the endoprosthesis material (usually titanium), firmly fixing it. Non-cemented prostheses are good for young patients. This facilitates further possible revision hip arthroplasty.
Cemented - all parts of the prostheses are fixed with a special biological solution. This method of connection provides reliable fixation even with osteoporosis. Cemented endoprostheses are best placed in elderly patients and people with reduced physical activity.
Hybrid-full - individual parts of the prosthesis can be made from different types of materials. The cup is fixed in a cementless way. Artificial legs are fixed with a solution. Hybrid endoprostheses are best recommended for middle-aged patients.

Price overview

In fact, the cost of arthroplasty consists of two parts. This is the price of the implant itself and the cost of the operation along with the stay in the inpatient department. Depending on the type and manufacturer, an endoprosthesis costs from 60,000–80,000 to 220,000–300,000 rubles. On average, an implant costs 130,000 - 150,000.

The average cost of a hip replacement surgery in Russian clinics is 170,000–250,000. The total amount depends on the conditions of stay and the duration of hospitalization. Total endoprosthetics, together with a hospital stay, costs an average of 350,000–370,000 (30,000–220,000 for unipolar prosthetics, 400,000–600,000 rubles for total). In different countries, it is estimated at between 8,000 and 40,000 dollars.

Manufacturing materials

When selecting an endoprosthesis for each patient, the surgeon takes into account his individual characteristics: lifestyle, age, weight, bone tissue condition. Depending on this, one or another implant material or a combination of them is selected: metal, polyethylene or ceramics.

For the young and active, high-strength prostheses with a friction unit (head and acetabular cup) ceramic-ceramic or metal-metal are optimally suited. With these combinations, the liner is either not required or it is thin, which allows the use of large heads, which significantly increase the range of motion of the hip.

Monoceramic ones are more expensive, but their strength characteristics are higher than those of metal ones, the wear rate is 0.0001 mm per year. Also, microparticles produced in a minimal amount during friction do not cause allergies or negative effects on organs.

Previously, ceramic prostheses were wary due to the high probability of splitting, but with the advent of the latest generations of ceramics Biolox forte and Biolox delta, produced by the German CeramTec factory, such fears are in vain. Leading manufacturers make the majority of ceramic components from this material.

Since the 1960s, arthroplasty with metal-polyethylene friction pairs has been popular in surgical practice due to its high wear resistance and reasonable cost: a metal head and an acetabular cup inlay made of high molecular weight polyethylene (“cross-linked”).

Ceramic heads are significantly harder, more scratch resistant and smoother than metal heads, so the ceramic-polyethylene friction unit lasts twice as long as the aforementioned metal-polyethylene option.

In polyethylene, additionally stabilized with vitamin E, wear resistance is significantly increased - up to 99%. Acetabular implants made from this material wear out at only 0.01 mm per year.

Osteoporosis as a cause of unreliable fixation of the prosthesis

The service life of the endoprosthesis is largely determined by the strength of its fixation in the bone cavity. This requires dense bone tissue, with which most patients have problems due to various diseases such as osteoporosis.

Osteoporosis is a loss of mechanical strength, a violation of the structure of the entire bone tissue due to an imbalance in the process
cell renewal. Due to the increased fragility of the bones in osteoporosis, fractures are frequent, including the femoral neck.

Normally, in a person aged 30-50 years, the number of destroyed bone cells is replaced by an equal volume of new ones. After the age of 50, approximately 1% of bone cells are lost per year. After 65, senile osteoporosis occurs, associated with natural weakening and wear and tear of the skeleton.

It is especially difficult for women - in the first year after the onset of menopause, the loss is 10%, then 2-3%. This is due to hormonal changes,
therefore, hormone replacement is popular in some countries
therapy to avoid loss of muscle and bone mass.

But the disease can begin to develop long before the due date for the following reasons:

smoking;
abuse of coffee and alcohol;
the predominance of meat in the diet;
lack of calcium and vitamin D3;
against the background of rheumatoid arthritis;
sedentary lifestyle.

If the patient has osteoporosis, then during prosthetics of the femoral neck, a bone fracture, crack or perforation is possible. Then additional fixing devices are used: screws and plates. But they can also break due to slow post-operative healing without the natural support of dense bone. During the operation of the implant, the screws sometimes change their position, which causes various kinds of injuries and the need for revision surgery. So, it is not necessary to talk about the long service life of the hip endoprosthesis in the presence of osteoporosis in the patient.

What to do after surgery

The postoperative period plays a key role in the longevity of the hip prosthesis. It is very important to constantly monitor the operated hip, observing its correct position:

sleep the first days only on the back, keeping the half-retracted position of the leg;
it is possible to turn on a healthy side, but only slightly retracting the prosthetic leg. For insurance, it is better to put a roller or pillow under it;
constantly sleeping on a healthy side is permissible no earlier than after 2 weeks;
for the first week, do not move the diseased hip with a large amplitude, do not make sharp and rotational movements;
under no circumstances bend the hip at an angle of more than 90 degrees (chairs should be high or put a pillow);
you can not cross your legs or lay one on top of the other;
It is very important to regularly perform special exercises.

After three months, the doctor will assess the condition of the joint on an x-ray.

How to reduce wear

Basic rules for extending the life of a hip endoprosthesis:

You should avoid various infections, colds, as this can cause inflammation in the area of the prosthetic joint.
It is impossible to gain excess weight after arthroplasty.
Avoid lifting and carrying weights, as well as sudden movements and jumps on the operated leg.
Do not allow the hip to bend more than 90 degrees, otherwise dislocation is possible.
Do not climb stairs quickly, especially steep ones.
Take preventive measures against osteoporosis: an active lifestyle, such as skiing or swimming, eat fish, dairy products, vegetables, vitamin supplements if necessary.

By following the simple rules that the attending physician will acquaint you with in detail, watching yourself in terms of weight and regularly performing a special set of exercises, you can significantly extend the life of even a not too expensive hip prosthesis. And ignoring all this - to get to the revision surgery much ahead of schedule, even with the most durable implant (often due to dislocation).

Revision operation

On average, a modern hip prosthesis lasts at least 15 years, and most of them (70%) quietly “survive” to 20 or 25 years and even longer. But still, there comes a time when further wearing of the implant becomes uncomfortable, pains appear, which many endure to the limit. Under no circumstances should this be done. The sooner the surgery is performed, the more successful the installation of a new prosthesis will be. Moreover, it happens that not the entire system needs to be replaced, but any one component.

Who is the operation for?

Orthopedic surgeries to replace a damaged joint are considered difficult.

The basis for the replacement are medical indications: high wear of this joint, trauma to the joints, bruises. Such limbs cannot fully function.

patients with arthritis;
arthrosis;
with fractures of the femoral neck;
dysplasia;
congenital anomalies;
oncological diseases.

Operation types

Hip prosthesis replacement can vary by type of surgery:

replacement of the surface of the hip joint;
complete replacement (total);
placement of a partial denture.

What are the designs

Only a doctor will help with the choice of an implant.

Choosing a hip joint prosthesis on your own, deciding which one is better is impossible, only a doctor determines with a similar one, analyzing the type of injury.

The classic version of the implant is a leg (pin), head, cups. Depending on the purpose, they distinguish:

by type of construction;
material.

Designs are unipolar, capable of replacing the functions of the head of the joint. Bipolar, replace the head of the femur and acetabulum. The main material for production was metal, plastic, ceramics, their combination.

Fixation methods

There are fixing methods:

mechanical (cementless), the product is wedged into the bone tissue, the junction is “masked” with a certain substance, after a while the bone “grows” with the product;
cemented, the product is completely fixed with a biological solution;
hybrid-hollow, when a product made of different materials is used, the cup is fixed in a cementless way, the legs are fixed with a biological solution.

Manufacturers and cost

The cost of the prosthesis depends on the material and manufacturer.

Brand models are in wide demand and popularity: DePuy, Zimmer, Stryker, B. Braun, Smith & Nephew, Biomet, Aesculap.

The cost is formed from the type of model, brand. It is difficult to answer how much a hip joint prosthesis in Moscow costs, its cost can vary from 60,000 rubles to 170,000 rubles.

Abroad, from $8,000 to $40,000. The price in Ukraine fluctuates between 25,000 - 85,000 hryvnia.

The rehabilitation process

The rehabilitation process takes a long time, the patient is recommended to use antibiotics. To prevent pathology: the formation of blood clots, thromboembolism, anticoagulants are prescribed.

The patient is explained how not to bend the leg (toe down, inward; turn 90 °). Sleeping is allowed on the back, not on the injured side.

Reviews

Igor Andreevich, orthopedist-traumatologist, St. Petersburg

“The implantation of prosthetic implants, hip joints, has long been used by medicine. The technique gives unambiguously positive results in young patients and children. It is more difficult with people of retirement age, but all the same, implanted prostheses “take root”, returning the motor function of the hips.”

Lydia, 37 years old, Moscow

“After the car accident, the right thigh literally twisted outward. The hip, tendons were completely damaged, I thought I would remain disabled for life, I could no longer walk on two legs. Doctors advised to implant a prosthesis in the hip joint, the cost, of course, was high. They paid about 450,000 thousand rubles (for everything together), but I do not regret the money. A year has passed, the functionality of the hip is fully restored.”

Cost of hip arthroplasty | Dr. Yolkin

The most effective method is a doctor, but without a thousand rubles. In the cost of materials. Sometimes incorrect (they have a large one of both sexes, which, taking into account the type to which the components and the acetabulum are selected). Endoprosthetics of the hip joint cannot be erased, the endoprosthesis is both domestic and

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What determines the cost of a prosthesis?

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Manufacturer

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Materials of the components of the endoprosthesis

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Fixation method

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What determines the total cost of the operation?

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Endoprosthetics of the hip joint - prices in the Moscow region | Found 1 price

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Preparing for the operation

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Endoprosthetics of the hip joint

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Postoperative period

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What can be called ideal?

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Prostheses with a cementless fixation method - in order to restore the function of the joint, its special layer, steel during the operation. Basic requirements (hip, knee). Now Rakant Mikhail in an adult or this pathology in the joint of the 2nd degree during the recovery of the patient's characteristics that determine the injuries suffered, we recommend contacting the German for 3-5 Zimmer prosthetics, which is produced only by an experienced specialist. Metal ions have bones "customized" under

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Main manufacturers and cost

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How to choose a surgeon

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Hip replacement: surgery, choice of prosthesis

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Indications for endoprosthetics

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Endoprosthesis surgery

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Rehabilitation after endoprosthetics

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What is a hip arthroplasty

A complex surgical operation that requires replacing worn or destroyed parts of the largest joint of bones in the body in the form of a hip joint (HJ) with artificial parts is arthroplasty. The "old" HJ is replaced by an endoprosthesis. It is called so because it is installed and located inside the body (“endo-”). The product is subject to the requirements of strength, reliability of fixation of components and biocompatibility with tissues and structures of the body.

The artificial “joint” bears more load due to the absence of friction-reducing cartilage and synovial fluid. For this reason, prostheses are made from high quality metal alloys. They are the most durable and last up to 20 years. Polymers with ceramics are also used. Several materials are often combined in one endoprosthesis, for example, plastic with metal. In general, the formation of an artificial hip joint is provided by:

prosthesis cup, replacing the acetabulum of the joint;
friction-reducing polyethylene liner;
head, providing soft sliding during movements;
the pedicle, which takes the main loads and replaces the upper third of the bone and the femoral neck.

Who needs

Indications for arthroplasty are serious damage to the structure and functional disorders of the hip joint, which lead to pain during walking or any other physical activity. This may be due to trauma or previous bone diseases. The operation is also necessary for stiffness of the hip joint, a significant decrease in its volume. Among the specific indications for arthroplasty are:

malignant tumors of the neck or head of the femur;
coxarthrosis of 2-3 degrees;
hip fracture;
hip dysplasia;
post-traumatic arthrosis;
aseptic necrosis;
osteoporosis;
osteoarthritis;
Perthes disease;
rheumatoid arthritis;
the formation of a false hip joint, more often in the elderly.

Contraindications

Not all people who need arthroplasty can have hip surgery. Contraindications to it are divided into absolute, when surgical intervention is prohibited, and relative, i.e. it is possible, but with caution and under certain conditions. The latter include:

oncological diseases;
hormonal osteopathy;
3 degree of obesity;
liver failure;
chronic somatic pathology.

Absolute contraindications include more diseases and pathologies. Their list includes:

foci of chronic infection;
absence of a medullary canal in the thigh;
thromboembolism and thrombophlebitis;
paresis or paralysis of the leg;
immaturity of the skeleton;
chronic cardiovascular insufficiency, arrhythmia, heart disease;
violation of cerebral circulation;
impossibility of independent movement;
bronchopulmonary diseases with respiratory failure, such as emphysema, asthma, pneumosclerosis, bronchiectasis;
recent sepsis;
multiple allergies;
inflammation of the hip joint associated with damage to the muscles, bones or skin;
severe osteoporosis and low bone strength.

Types of hip endoprostheses

In addition to classification by materials, hip endoprostheses are divided according to several other criteria. One of them is based on the components of the prosthesis. He can be:

Unipolar. In this case, the prosthesis consists only of a head with a stem. They replace the corresponding parts of the hip joint. "Native" remains only the acetabulum. Today, such a prosthesis is rarely used. The reason is that the risk of destruction of the acetabulum is high.
Bipolar, or total. This type of prosthesis replaces all parts of the hip joint - the neck, head, acetabulum. It is better fixed and maximally adapted to the body. This increases the success of the operation. The total prosthesis is suitable for older people and young people with their high activity.

Endoprosthesis service life

The number of years that an endoprosthesis can last depends on the materials used in the manufacture. The strongest are metal. They serve up to 20 years, but at the same time they differ in less functional results in relation to the motor activity of the operated limb. Plastic and ceramic prostheses can boast of a shorter service life. They can serve only 15 years.

Types of endoprosthetics operations

Depending on the prostheses used, arthroplasty can be total or partial. In the first case, the head, neck and acetabulum of the articulation are replaced, in the second case only the first two parts are replaced. Another classification of the operation uses the method of fixation of the endoprosthesis as a criterion. Ceramic or metal must be firmly connected to the bones so that the hip joint can fully work. After choosing the endoprosthesis and its size, the doctor determines the type of fixation:

Cementless. Fixation of the implant in place of the hip joint is carried out due to its special design. The surface of the prosthesis has many small protrusions, holes and depressions. Over time, bone tissue grows through them, thus forming an integral system. This method increases the recovery time.
Cement. It consists in attaching the endoprosthesis to the bone due to a special biological glue called cement. It is being prepared during the operation. Fixation occurs due to the hardening of the cement. Recovery of the hip joint in this case is faster, but the risk of implant rejection is high.
Mixed or hybrid. It consists in a combination of both methods - cement and cementless. The leg is fixed with glue, and the cup is screwed into the acetabulum. It is considered the most optimal way to fix the prosthesis.

Preparing for the operation

The first event before the operation is a doctor's examination of the legs. Radiography, ultrasound and MRI of the operated area are used as diagnostic procedures. The patient is hospitalized two days before the scheduled operation for a number of procedures that will help eliminate the presence of contraindications. Held:

blood coagulation analysis;
OAM and UAC;
determination of blood group and Rh factor;
biochemical blood test;
tests for syphilis, hepatitis, HIV;
consultations of narrower specialists.

Further, the patient is provided with information about possible complications, they are offered to sign a consent to surgical intervention. At the same time, instruction is given on behavior during and after the operation. Only a light supper is allowed the night before. You can't eat or drink in the morning. Before the operation, the skin in the thigh area is shaved, and the legs are bandaged with elastic bandages or compression stockings are put on them.

Operation progress

After transporting the patient to the operating room, I give him anesthesia - full anesthesia with controlled breathing or spinal anesthesia, which is less harmful, therefore it is more often used. The hip replacement technique is as follows:

after anesthesia, the doctor treats the surgical field with antiseptics;
then he dissects the skin and muscle, making an incision of about 20 cm;
then the intra-articular capsule is opened and the femoral head is removed into the wound;
then comes its resection until the bone marrow canal is exposed;
the bone is modeled taking into account the shape of the prosthesis, it is fixed using the chosen method;
using a drill, it processes the acetabulum to remove cartilage from it;
a cup of the prosthesis is installed in the resulting funnel;
after installation, it remains only to compare the prosthetic surfaces and strengthen by suturing the incised wound;
a drain is inserted into the wound and a bandage is applied.

Temperature after hip arthroplasty

Within 2-3 weeks after the operation, an increase in temperature may be observed. This is considered normal. In most cases, the body tolerates high temperatures well. Only in very bad condition can you take an antipyretic pill. It is only necessary to inform the doctor if the temperature rises after a period of several weeks, when it was normal.

Rehabilitation

The operation to replace the hip joint requires the start of rehabilitation in the first hours after its completion. Rehabilitation activities include physiotherapy exercises, breathing exercises and early activation in general. The leg should be in functional rest, but movement is simply necessary. You can not get up only on the first day. Changing the position of the body in bed, performing slight flexions in the knee joint may be allowed by the doctor. In the following days, the patient can begin to walk, but with crutches.

How long does it take

Rehabilitation within the walls of the clinic lasts about 2-3 weeks. At this time, the doctor controls the wound healing process. Postoperative sutures are removed approximately on the 9-12th day. Drainage is removed as the discharge decreases and completely stops. For about 3 months, the patient must use the means of support when walking. Full walking is possible after 4-6 months. Approximately how long does rehabilitation after hip arthroplasty last.

Life after hip replacement

If a person is somatically healthy and has no concomitant diseases, then he is able to restore the functionality of the leg almost completely. The patient can not only walk, but also play sports. You can not perform only exercises related to the power tension of the limbs. Complications after endoprosthetics are observed more often in the elderly or in case of non-compliance with the postoperative regimen.

Disability after arthroplasty

Not all cases of hip replacement lead to disability. If the patient is in pain and unable to do his job normally, then he can apply for it. Recognition of a person as a disabled person is carried out on the basis of a medical and social examination. To do this, you need to contact the clinic at the place of residence, go through all the necessary specialists.

The basis for disability is often not the endoprosthesis itself, but the diseases that required surgery. Specialists consider the severity of impaired motor functions. If, after surgery, reduced functionality remains in the hip joint, then the patient is given a 2-3 disability group for 1 year with the possibility of subsequent re-registration.

Operation cost

Almost all patients are interested in the question of how much a hip replacement costs. There are several programs for which this operation can be carried out:

free of charge under the CHI policy (in this case, you may face a queue for 6-12 months in advance);
for a fee in a private or public clinic;
free of charge under the quota of high-tech medical care (circumstances are necessary here for the provision of benefits).

In addition to the cost of the operation itself, the cost of a hip joint prosthesis is also important. It depends on the reason that led to the need for endoprosthetics. With coxarthrosis, the cost of the prosthesis will be higher than with a fracture of the femoral neck. The approximate cost of hip replacement surgery and prosthesis is shown in the table:

Today, there are any manufacturers on the market of medical implants - Russian, European, American, and Chinese. We work with leading manufacturers of endoprostheses, most often we use ZIMMER (USA) and Smith&Nephew (USA) endoprostheses. Questions like “Is Swiss better”, or “I heard that American ones are worse than English ones”, etc. don't make sense at all. No normal surgeon would put a bad prosthesis, and they already (bad prostheses), it seems, are not being produced. The main thing is that the installed prosthesis should correspond to a particular patient with all its features, and be correctly installed.

Almost all major firms have a wide range of implants that differ in design, materials, and some other parameters. It is important that the optimal endoprosthesis can be selected for each patient - both for young active patients who will engage in permitted sports, and for the very elderly, when the quality of the bone is worse than the surgeon would like.

In recent years, in 99% of cases, we use endoprostheses with cementless fixation to the bone, cementing is used only in cases where there are no other options (very pronounced osteoporosis is the main reason).

The main parameter that determines the survival of the endoprosthesis is the material of the friction pair. The most "tenacious" today is a pair of "ceramics-ceramics" (delta-ceramics). The wear of rubbing surfaces in such prostheses is so small that it can even be ignored - a person simply will not have time to wear out such a joint in a lifetime. A simpler option is ceramic-polyethylene and metal-polyethylene pairs. The ratio of the wear rate in the three listed options is approximately as follows: 0.00001: 0.01: 0.1 mm/year. Thus, the most wear-resistant prostheses are shown to young people, the ceramic-polyethylene pair to middle-aged people, and the metal-polyethylene pair to older people. In all variants, any high-quality endoprosthesis, provided that it is properly installed and operated reasonably, will last at least 15-20 years. There are joints for very elderly patients with hip fracture - unipolar, as well as bipolar and dual head mobility joints. There are oncological endoprostheses for cases when large bone defects have to be replaced.

In the event that an endoprosthesis was installed for a person a long time ago, and it is worn out, or there is some problem with the prosthesis or the surrounding bone, an operation is performed to replace it - i.e. revision arthroplasty. In some cases, you can get by with a simple replacement of one prosthesis (or components) with another, but often (especially after cement prosthetics) you have to do quite traumatic operations to remove the old prosthesis and bone cement, and replace it with a revision one, more complex and cumbersome. In any case, there are no unsolvable technical problems today - arthroplasty has become one of the most well-established operations. A few years ago, we had the opportunity to receive individual components of endoprostheses for complex cases with large bone loss. Such components are printed from titanium powder on a 3D printer according to computed tomography data. Most often we are talking about fragments of the pelvis.

A few examples of modern endoprostheses used by us can be seen below.

Here is an interesting example of bilateral arthroplasty. Much to my regret, I did not make a video of walking before the operation, but, take my word for it, it was still a gait. Below you can see radiographs sequentially - before the operation - after the first operation - after the second operation. You don't have to be a radiologist to appreciate the difference.

And here is the video - a year after the first, and 6 months after the second operation:

Of course, not all patients manage to rehabilitate in this way, however, there would be a desire)))

General principles

The choice of material when creating any implant is an important step, often determining the success of the entire complex of developmental research and production work. In this case, two main principles should be taken into account, which, reflecting the close interconnectedness of design and material, can be taken as the basis of medical materials science: 1) the technical and biological features of the design depend on the corresponding features of the material; 2) new materials allow the implementation of new implant design options.

The main design task in creating a total endoprosthesis is to obtain a permanent, long-term functioning implant that eliminates pain and improves the functionality of the hip joint by reproducing its normal spatial geometry, mobility and support ability with artificial articulating components.
The secondary tasks of the general plan are most often considered: simplicity of design and application, saving attitude to tissues during implantation, reliability and high resistance to destruction and wear, durability of functioning, ease of use, minimization of technical difficulties when replacing worn and destroyed implants, convenience for industrial production , cost reduction.

Everything is currently total hip replacements principally include two components: acetabular (acetabular) and femoral. The main requirement for materials for the manufacture of an endoprosthesis is biocompatibility, defined as the ability of a material to cause an acceptable response of a macroorganism or not cause it at all. The negative impact of the material and the products of its wear or degradation should not lead to significant local, systemic and long-term effects, and the positive impact may be in the form of a number of useful manifestations required for solving the problems of endoprosthetics, for example, adhesion or bone tissue ingrowth.

The materials that are currently used in hip arthroplasty include: metals and their alloys, ceramics, bone cement (polymethyl methacrylate), polyethylene.

The main materials from which endoprosthesis components are made

Metals

The general requirements for metals used for the manufacture of endoprostheses are: rigidity, strength, elasticity, corrosion resistance, the ability to create the required surface structure and biocompatibility.

Stainless steels (Fe, C, Or, Ni, Mo) are characterized by a low carbon content, which determines their resistance to corrosion and mechanical stress. The strength of stainless steel can be improved by cold forging. BioDur108 steel alloy, containing Ni, with a high nitrogen content and having significant corrosion resistance and better strength characteristics, is used for the manufacture of cemented endoprosthesis stems.

Titanium and its alloys (CP-Ti (pure titanium - 98 - 99.6%), Ti-6AI-4V, etc.) are characterized by high corrosion resistance and biocompatibility. Pure titanium is more viscous, it is used for porous coatings, fiber metal. Alloy Ti-6A1 -4V has a high mechanical strength. The modules of torsion and axial stiffness are closest to the bone. The alloy is sensitive to damage associated with the formation of microcavities and has a high surface softness.

New titanium alloys - R-titanium (R-Ti) - are characterized by the predominance of the R-phase of the alloy, often due to the high content of Mo (more than 10%), which makes it possible to increase the resistance to fracture, primarily to fatigue, and also by 20%. reduce the modulus of elasticity, bringing it closer to the modulus of elasticity of the bone. Ti-5AI-2.5Fe, Ti-6AI-17 Niobium do not contain relatively toxic V, have a lower modulus of elasticity. Ti-Ta30 has a thermal expansion modulus close to ceramic, which reduces the risk of fracture when combined with metal implants. All titanium alloys are not resistant to debris formation. More often they are used for the manufacture of cementless legs, sometimes after surface hardening by oxidation or proton bombardment, and less often - cement.

Co-Cr alloys (Co-Cr-Mo, Co-Ni-Cr-Mo, Co-Cr-Ni-W, Co-Ni-Cr-Mo-W-Fe) are highly corrosion resistant, possibly have some toxicity and immunogenicity due to the presence of nickel. Co-Ni-Cr has poor frictional properties and forms a large amount of debris. Co-Cr-Mo has high hardness and strength, it is applicable in friction pairs in the manufacture of endoprosthesis heads, as well as in metal-to-metal friction pairs. The latter are characterized by extremely low wear, do not form a large amount of debris, but their use is limited by significant disadvantages: excessive rigidity (partially overcome by installing a metal insert in a polyethylene base), which increases the risk of loosening of the femoral and acetabular components of the endoprosthesis; duration of running-in of rubbing surfaces; an increase in the concentration of metal ions in biological fluids and tissues (toxicity, allergenicity, possibly oncogenicity and teratogenicity); high sensitivity to impingement; risk of osteolytic reactions of bone tissue, high cost. A variant of the metal-to-metal friction pair is the Co-Cr pair with the integration of corundum crystals (Metasul), providing even lower wear.

Zr and Ta alloys have high corrosion resistance, biocompatibility, surface hardness, and low debris formation. It is possible to create trabecular metal. True tantalum-based trabecular metal can significantly increase the possibilities of osseointegration, while not creating the problem of zones of connection of media of different strength.

The surface of the metal components of endoprostheses can be:

polished (heads, cup liners with metal-metal friction pairs, cement-fixed legs);
rough, which is created by processing in a stream of sand (legs and cups of cementless fixation 5-8 microns);
porous, which is created by sintering balls or wire (legs and cups without cement fixation);
trabecular, obtained by plasma spraying with metal (cups, as well as cementless fixation legs);
coated with hydroxyapatite, calcium phosphate, etc.

The surfaces of the metal components of endoprostheses may not interact with the surrounding tissues, may form a fibrous block, be fixed due to bone adhesion (in the presence of coatings such as hydroxyapatites), as well as due to impaction of the surrounding bone (press-fit) or its ingrowth (rough surface, fibro- and trabecular metal) (Fig. 1).

Rice. 1. Examples of osseointegration of the acetabular and femoral components of the endoprosthesis.

Ceramics

The improvement of ceramic materials has made it possible to consider them as some alternative to metal alloys, and according to some of their characteristics, primarily tribological, the ceramic-ceramic pair has unique properties.

From the point of view of interaction with body tissues, ceramic materials can be divided into 3 groups:

inert ceramics that retain the shape of the implant and the surface structure without tissue ingrowth;
bioactive ceramics that preserve the shape of the implant and its internal structure with ingrowth of surrounding tissues;
biodegradable, which loses its shape, surface and internal structure of the implant with ingrowth into it, partial or complete replacement
by surrounding tissues.

When creating endoprostheses, the following types of ceramics are used:

Based on oxides of Al, Zr, Ti (Al 2 O 3 ZrO, TiO): bioinert, with high biological compatibility and surface strength, applicable in the creation of ceramic-polyethylene and ceramic-ceramic friction pairs. Zirconium ceramics due to the admixture of yttrium is characterized by some toxicity.
Carbon ceramics (C with different structure, C-Si): bioinert, with good biocompatibility and surface strength. It is applicable for covering the legs and cups of prostheses, as well as in creating friction pairs.
Calcium phosphates and aluminates (Cryst-Ca 5 (PO) 3 (O), CaAl 2 O 3): bioactive, non-biodegradable. They can provide interaction between bone and other biomaterials, be carriers of medicinal and biologically active substances (short duration, surface release). Applicable for biomaterial-induced and biomaterial-dependent osseointegration.
Calcium sulfates, aluminates and phosphates (CaSO 4 , CaAl 2 O 3 , Amorph-Ca 5 (PO 4) 3 (OH)): biodegradable, with different replacement periods, can be carriers of medicinal and biologically active substances (long-term release). A similar role in the creation of endoprostheses.

The advantages of ceramic friction pairs are high wear resistance and higher surface finish, high bioinertness, corrosion resistance. Disadvantages: increased rigidity of a ceramic-ceramic pair, a tendency to destruction, including spontaneous destruction in case of violation of the production technology or implantation, as well as causticity (especially ceramic-ceramic pairs) (Fig. 2). The appearance of ceramic debris leads to catastrophically increasing wear of the friction pair (both ceramic-polyethylene and ceramic-ceramic), increased formation of destruction products with the induction of osteolysis processes in the implant bone beds and fibrosis in soft tissues. During revision operations, a separate problem is the impossibility of complete removal of the remains of ceramic particles from the primary endoprosthesis, which increase the wear of the already revision friction pair.

Rice. 2. Destruction of the ceramic head of the endoprosthesis.

The feasibility of using bioactive and biodegradable ceramic coatings is debatable. On the one hand, they improve the process of osseointegration and have an osteoconductive effect; on the other hand, with thick-layer application, there is no complete bone replacement of the ceramic, and its remains under long-term cyclic loads, exfoliating from the metal surface of the implant, can induce the formation of wear products and osteolysis.

Polyethylene

There are low, medium-low, high, ultra-high and ultra-high density cross-linked polyethylenes. Polyethylene is used to create a friction pair. Currently, ultra-high density polyethylene and its derivatives are widely used, as a rule, for the manufacture of the acetabular component. A pair of friction metal (endoprosthesis head) - polyethylene (cup or insert) is still the reference. To modify ultra-high density polyethylene in the late 1970s, carbon fibers were used to increase the modulus of elasticity and wear resistance, reducing the ability to deform (Product Poly II, Zimmer). However, application experience has shown a higher frequency of destruction of elements from Poly II, including surface ones. This was partly due to the poor reproducibility of the manufacturing technology. In the early 90s of the last century, the technology of crystallization of ultra-high density polyethylene without breaking molecular chains and losing molecular weight (Hylamer, DePuy) appeared, which was characterized by an increase in the strength of the product and its resistance to oxidation.

Sterilization of polyethylene products by high-dose gamma irradiation leads to the occurrence of oxidative reactions in them in the form of two main directions: molecular chain breaking and cross-linking. Moreover, if polyethylene degradation reactions predominate on the surface of the sample, then the level of cross-links between its molecules increases in depth.

The technology for creating cross-linked polyethylene, which makes it possible to ensure their formation throughout the entire volume of the substance, as well as to suppress degradation reactions, has led to the production of a high-strength and wear-resistant material, approaching metal-to-metal friction pairs in these parameters, however, avoiding such disadvantages of metal joints as hardness, toxicity and allergenicity (by increasing the concentration of cobalt, nickel and chromium ions in the blood). However, the experience of using cross-linked polyethylene showed that, despite the promise of experimental and first clinical results, there is an instability in the production technology of this material, as well as an increased risk of destruction of products from it under shock loads.

Thus, until now, the most applicable is the standard ultra-high density polyethylene, including the recrystallization option, and cross-linked polyethylene remains highly promising as a new version of a high-strength friction pair.

bone cement

Numerous studies have shown that the advantages of cement prosthetics include the possibility of using simple implant models, the absence of continuous contact of the metal elements of the prosthesis with the bone, the possibility of creating a depot of antibiotics in the surgical area, ensuring stable fixation of prosthesis elements in the presence of post-traumatic and dysplastic defects of the bone bed and osteoporosis of various types. genesis.

The main factors that improve the mechanical quality of cement microadhesion with bone are identified: careful cleaning of the bone bed before cementing, strength and local regenerative capabilities of the bone, quality of cement mixing, use of a cement-tight supply device. For a comprehensive solution to the problem of improving the quality of cement fixation, a system of measures has been developed. The main ones are: distal plug of the femoral canal, retrograde filling of the femoral canal with bone cement, drainage of the femoral bone marrow canal during its filling with cement, formation of holes in the acetabulum for fixation of the acetabular component, vacuum mixing of cement, washing of the cemented bone surface with a pulsating jet (pulsating lavage), cleaning the surface to be cemented with nylon brushes, dehydration of the bone surface before cementing, pressurization of the cement during the installation of the prosthesis. There is evidence of an increase in the efficiency of cementation during centrifugation during mixing. The high quality of cement preparation, its insertion into the bone and the uniform distribution of the cement mantle are ensured by a number of developed devices and equipment. These include: various types of vacuum mixers that prevent the formation of air bubbles in the cement mass ; special syringes for retrograde supply of cement into the cavity, and, above all, into the femoral canal; polyethylene restrictive plugs and guides forming a cement mantle in the femoral canal; finally, devices for pressing or pressing the cement into the bone pores during its laying. The use of improved cementing technology has reduced the number of revisions for infectious complications and implant replacements due to aseptic loosening.

As a rule, bone cement consists of two components - a powder (polymer) and a liquid (monomer). The polymer is the main part of bone cement; the main consumer properties of cement depend on its composition. In some types of cement, copolymers are added to polymethyl methacrylate, for example, methacrylate, butyl methacrylate, stearin. Thus, the addition of methacrylate increases the hydrophilicity of cement, increases its flexibility and viscosity. The addition of stearin increases not only the hydrophobicity, but also the fatigue properties of the cement. The addition of barium sulfate imparts radiopacity to the cement.

The main brands of cement from various manufacturers and the type of polymer, types of monomer, the ratio of liquid and solid parts of the main brands of bone cement and the maximum temperature of their polymerization are presented in the tables.

Main brands of cement and types of polymer

Temperature and polymerization time depending on the brand of cement and the percentage of monomer

Grade of cement	Monomer	Polymerization temperature	Curing time
Boneloc	50% methyl methacrylate 20% isobornimethacrylate 30% n-decyl methacrylate	36°C	11:00
Cemex RX	100% methyl methacrylate	44°C	13:20
Sulfix-6	85% methyl methacrylate 15% butyl methacrylate	48°С	10:50
Palacos R	100% methyl methacrylate	56°C	10:40
CMW3	100% methyl methacrylate	65°С	10:50
simplex	100% methyl methacrylate	69°С	11:50

When cement is introduced into tissues in the body, both local and general reactions can occur. The high temperature during cement polymerization can be accompanied by damage to the bone in contact with the cement or implant, especially due to the denaturation of the protein structures of the bone tissue. At a cement mantle temperature of 72°C, bone necrosis occurs almost immediately. A temperature of 60°C causes necrosis after 5 seconds of exposure, 55°C - after 30 seconds, 47°C - after 1 minute. Manufacturers are looking for ways to reduce the effect of temperature on fabrics. The general reaction of the body due to the toxic effect of cement is a short-term decrease in blood pressure, transient bradycardia. This reaction is more pronounced when using low-viscosity cement grades.

The dosage of the mixing components is as follows: 10 ml of the liquid component and 20 g of the powder, or 20 and 40 ml, respectively, per 40 and 80 g of powder. You can mix in an open container with a flat spoon or in a special vacuum mixer. The quality of mixing is better in the mixer, but the curing time of the cement depends on the ambient temperature and mixing speed.

Cement acquires antimicrobial properties when antibiotics are introduced into it. The most commonly used antibiotic is gentamicin (Polakos, CMW). Tobramycin was introduced into Simplex cement (England). In recent years, vancomycin has been added to cement more frequently. Independent addition of antibiotic powder to bone cement during surgery is unacceptable, as the chemical structure of bone cement changes. It is better to increase the dose of antibiotic for intramuscular administration.

Dependence of cement preparation time on ambient temperature

R.M. Tikhilov, V.M. Shapovalov
RNIITO them. R.R. Vredena, St. Petersburg

Hip arthroplasty is often the only possible way to return to full activity and avoid disability in patients who have suffered a fracture of the femoral neck. Replacement of the femoral head, acetabulum and the hip joint itself with a prosthesis made of chemically and biologically inert materials can significantly reduce pain, restore full joint mobility and preserve limb functions.

What is an endoprosthesis

The endoprosthesis of the hip joint is its artificial imitation and consists of the following parts:

cups - an artificial acetabulum with a polyethylene liner;
the head of the prosthesis, which is a hinge, usually spherical;
stem implanted to the medullary canal of the femur, round or square in cross section.

Endoprostheses are designed in such a way that they can fully preserve all the functional features of the hip joint. Prostheses can differ in the method of attachment, as well as in the materials of manufacture - both are taken into account individually, since the selection of the prosthesis is carried out taking into account the age, weight, expected physical activity of the patient and many other factors.

In what cases is the replacement of the joint with an endoprosthesis indicated?

Indications for an artificial hip replacement surgery are:

Classification of implants

Depending on the design of the endoprosthesis, the method of their attachment to the femur, and the materials of the rotational cup-head pair, several types of implants are distinguished.

Types of implants by their design

Depending on whether an acetabular prosthesis is intended or a natural recess will be used to accommodate the head of the prosthesis, two types are distinguished:

unipolar - without prosthetics of the acetabulum;
bipolar - with a cup imitating the acetabulum.

The most technically advanced and durable are bipolar prostheses, as they allow reducing the abrasion of cartilage tissue by the head of the prosthesis.

Types of implants according to the method of their attachment

Depending on the method of fixing the implant in the medullary canal and pelvic bone, there are:

Endoprostheses with cementless fastening. Such constructions are inserted into the bone tissue without any fixing compositions, in the expectation that over time there will be an "ingrowth", consolidation of the implant with the bone tissue. Implants of this type have a special porous shell into which bone tissue grows over time. This method is most often used in operations in young patients, since in them the processes of regeneration and tissue repair occur most quickly and actively, allowing you to fix prostheses without clamps.
Endoprostheses with cement fastening. In elderly patients, as well as in patients with autoimmune, endocrine, genetic diseases that reduce bone density and strength, the prosthesis is most often fixed with special cement.
Endoprostheses with a mixed method of attachment. Implants of this type combine two methods of attachment at once: a cup imitating the acetabulum is attached to the pelvic bone in a cementless way, and the prosthesis leg is fixed in the medullary canal with cement.

Types of implants according to the materials of manufacture

Depending on the materials from which the friction pair is made - the bowl and the head of the prosthesis - it is customary to distinguish the following types:

Metal - polymer. The stem and head of the prosthesis are made of a biologically and chemically inert metal, most often titanium, and the acetabular cup is made of a special polymer. The soft polymer material of the bowl can significantly reduce friction. This type of implant is one of the most affordable. The friction products of the polymer do not enter the bloodstream and can only cause local reactions in the form of tissue edema, as well as increase the risk of loosening of the parts of the prosthesis in the bone tissue. Many manufacturers create products with a polymer cup impregnated with vitamin E to reduce the destructive effect of friction products on bone membranes.
Metal is metal. All parts of the prosthesis are made of metal. Implants of this type are used less and less, as the products of friction of metal parts against each other often cause complications, including metallosis. The smallest chips formed by rubbing the head against the bowl enter the bloodstream, causing local and systemic reactions of the body. Prostheses with a pair of metal-metal rotation often cause swelling in the area of the operation, which limits the patient's mobility.
Ceramics - ceramics. All parts of the prosthesis are made of heavy-duty ceramics. Such implants are considered among the best, as they create minimal friction and rarely cause postoperative complications. Due to the complexity of execution, the price of a ceramic hip joint is relatively high. The disadvantages of implants of this type include the characteristic crunch emitted by its parts during rotation, which often becomes a cause for concern for patients.
Ceramics - polymer. In prostheses of this type, the stem and head are made of heavy-duty ceramics, and the bowl is made of polymeric materials. Due to the low degree of thorns and high wear resistance, this type of prosthesis can be attributed to the most commonly used. The disadvantage of this type of prosthesis can be considered their fragility: excessive loads can cause the destruction of the implant.

Manufacturers of hip endoprostheses

Among the most widely represented materials for endoprosthetics on the market, the following companies can be distinguished:

Zimmer (Zimmer) is an international corporation based in the USA and has more than a century of history. The company supplies its products to medical centers in the USA, Germany, the Czech Republic, Russia, and Israel. The assortment includes a wide range of products from simple metal-polymer to high-tech ceramic prostheses. In the recent past, the company merged with another major manufacturer of implants, Biomet.
Johnson&Johnson is a world-famous corporation based in the USA, the manufacturer of the Pinnacle line of prostheses, which are widely used worldwide for hip replacements.
Stryker is a company founded by physician G. Stryker in the 1940s in the USA. The company's products are well established in the market due to their high quality, but the cost of the company's products is relatively high.
Smith&Nephew is a UK-based company that offers wear-resistant and durable products over a century ago. It is one of the largest suppliers of medical equipment worldwide.

In the world market, an increasing share is being taken by the products of companies from China and Taiwan, offering products at a lower cost. However, there is no exact data on the quality of products from Asian manufacturers, since in our country the percentage of their installation remains very low.

Average cost of hip arthroplasty

The price of endoprostheses of the hip joint varies depending on the materials that were used in its manufacture and the manufacturer.

A classic bipolar prosthesis with a metal-polymer friction pair, when properly used, can have a long service life up to life. The cost of such a product varies in the range from 90 to 150 thousand rubles. Analogues at a lower cost can be found in Asian manufacturers of medical equipment.
A metal unipolar prosthesis made of titanium can cost from 75 thousand rubles and more. Bipolar - from 100 and above, respectively.
Ceramic prostheses with the lowest coefficient of friction and wear are among the most expensive: the price of products of this type starts from two hundred thousand rubles.

How to choose an implant

The choice of an endoprosthesis is a very individual process, there is no material, shape, method of attachment that is ideal for all patients at once. The choice of the type of endoprosthesis is the task of the surgeon who will perform the operation to install it. Weight, age, bone density, general health, lifestyle - all of these factors will be taken into account when choosing prosthetics.

When choosing an endoprosthesis, it is necessary to take into account the age, weight and activity of the patient.

Prostheses with a metal-polymer rotation pair are most suitable for people over 60 years old, but they can also be used in younger people, provided that they do not play sports and other types of physical activity that involve increased stress on the articular joints. Friction products of a high-molecular polymer do not penetrate into the bloodstream and cannot cause systemic reactions, however, they increase the risk of loosening of the cup in the acetabulum or the leg of the prosthesis in the bone canal. When using this type of product, an annual radiographic examination is recommended to assess the condition of the polymer bowl.

Prostheses with a metal-to-metal friction pair are most often used by people who lead an active lifestyle, including professional athletes, who need a wide range of motion and high wear resistance of the product. These types of artificial joints are suitable for patients with large body weight due to the high load on the musculoskeletal system. There is evidence that prostheses with this friction pair cause more complications in female patients than in men, but the reasons for this dependence have not yet been found. The use of endoprostheses of this type is not recommended in women planning future pregnancy.

Ceramic prostheses are suitable for all age groups, however, due to their high cost, the use of this type of product is not always advisable. The disadvantages of ceramic joints include their relative fragility: a strong impact, for example, when falling, can cause their destruction.

The high cost and quality of the prosthesis do not guarantee the success of the operation; the experience and professionalism of the surgeon are much more important.

Rehabilitation plays one of the most important roles in the success of treatment. In medical practice, there are many cases when patients, despite all the prescriptions of doctors, refused to perform rehabilitation measures, citing the fact that the high cost of the prosthesis should minimize the risks of complications, and eventually, after a few years, they were again forced to seek medical help. due to pain in the area of the replaced joint. Unfortunately, conservative treatment in this case is impossible, the only way out is a repeated revision intervention followed by a long rehabilitation period.

Endoprosthesis installation technique

When choosing a technique for installing an endoprosthesis, several factors are taken into account at once:

the age of the patient and his state of health;
condition and density of bone tissue;
the scale and nature of pathological changes;
personal experience of the surgeon.

Access to the area of operation can be carried out posteriorly, anteriorly, anterior-laterally or in a combined way. In most cases, it is the posterior approach to the area of prosthetics that is used as the least traumatic.

After the incision is made, the surgeon exposes the joint capsule, shifting the fascia and muscles, and resects the damaged areas. The head of the femur is removed, the acetabulum is scraped or also completely removed. The medullary canal is cleaned, and the leg of the prosthesis is fixed into it with the help of cement or metal rods. The bowl is fixed in place of the acetabulum. Next, the distal region of the prosthesis is checked, if no deviations are found, its head is fixed in the bowl, and then the tissue layers are sutured in layers.

Replacement of the hip joint with an artificial one is a complicated but often necessary operation. In most cases, only prosthetics allow the patient to avoid prolonged immobilization, which is associated with the risks of developing complications in the cardiovascular and respiratory systems, which often cause death in elderly patients, or deep disability.

Compliance with the doctor's instructions and the implementation of the prescribed rehabilitation measures allows you to return to a full-fledged active life in a short time, and with proper use, replacement of the prosthesis may never be necessary during your life.

Modern types of prostheses are designed to completely imitate the native joint and fulfill its functional abilities.

Recently I read (-la) that the most reliable prosthesis is made of ceramics.
A cemented denture is an obsolete model, while a cementless denture is a good option.
The best prostheses are foreign, they have positive reviews.

The first myth that should be dispelled is that there is no best endoprosthesis.

Models of leading foreign firms do not have any particular differences, so it is difficult to say which one is better. Comparison - rather by the standards of price-quality. Well-known firms Zimmer, De-Puy, Biomet produce equivalent samples that do not have pronounced differences.

When choosing a prosthesis, look not at the company or cost, but at a more important feature that affects the life of the adaptation - a friction pair.

Types of endoprostheses, their differences

Features and differences are distinguished by the type of arthroplasty:

superficial. The head of the hip joint and the acetabulum are replaced;
total. Complete replacement of damaged bone and cartilage with excision of the femoral neck.

Implants are distinguished by the method of attachment:

Fixation without medical cement. It is used for young patients without signs of osteoporosis. With good bone density, they grow into the prosthesis and secure it. With cementless fixation, a stem having a titanium alloy can be used.
Fastening with cement. The technique is used in the elderly or in patients whose bone density does not allow the use of a cementless method.

Recently, you can often hear the concept of "liquid implant". It is not related to full-fledged endoprosthetics, since it is not a prosthesis. It is supposed to introduce certain types of acids, the purpose of which is to restore the connective tissue of the cartilage. Any expert will tell you that this is impossible. Under the influence of the degenerative-dystrophic process, pathologies, the joint is completely destroyed and does not have the ability to regenerate. The only way out is surgery.

There are the following varieties:

metal combined with metal;
metal and polyethylene;
ceramics plus ceramics;
combination of ceramics and polyethylene.

Variety	Positive sides	Negative sides
Combination of pottery and ceramics	Friction components are non-toxic High wear resistance Possibility to choose a large head diameter	High risk of material splitting during physical exertion Relatively high price Often causes squeaks
Metal combined with metal	Short service life Material stability, high mobility New models are released annually, more advanced (there is plenty to choose from)	low price High toxicity of friction products The cup is sensitive to inclinations, it is advisable not to exceed 50 degrees
Metal and polyethylene	Budget implant, the cost is more affordable The most popular type of friction pair In combination with a low price has a decent quality Cup angle tilt can reach 90 degrees	Less durable than other types Head diameter not available over 32mm There is some toxicity, although quite moderate
Ceramics and polyethylene	The best prosthesis. Suitable for everyone without exception, although it is recommended for older people with a passive lifestyle	Service life is quite long

More often used ceramics in combination with polyethylene: suitable for patients of any category, has no age restrictions. Revision replacement intervention may be needed after 15-20 years.

From 10 to 15% of complications after arthroplasty are associated with incorrect selection of the prosthesis, and more specifically, friction pairs. That is why it is important to find a qualified orthopedist and pay attention not to the brand of the implant, but to its quality.

Hip joint: prosthesis price

The price of orthopedic structures depends on the manufacturer and the material used. Foreign companies offer implants in the region of 1300-2000 dollars, domestic ones are several times cheaper.

Where to buy a hip prosthesis?

You will deal with the purchase of an implant to replace the hip joint directly with your doctor. It is they who cooperate with manufacturers and will be able to say how much a certain type costs.

Dislocation of the hip prosthesis

the development of a pain syndrome that is not amenable to relief with painkillers;
change in the length of the lower limb, its shortening;
violation of the amplitude of movement, stiffness, a sharp decrease in physical activity.

To clarify the stability of the design, the patient is introduced into a state of anesthesia, where the doctor deliberately subluxes the prosthesis, then sets it back to its original position. This procedure allows us to assume the causes that provoked the complication, and in the future to reduce the risk of re-dislocation.

The treatment consists in the reduction of the dislocation and the subsequent wearing of a special prosthesis, a course of physiotherapy exercises, physiotherapy, and massage.

Zimmer: hip prostheses

Such popularity is associated with the quality of products: it is distinguished by durability and high adaptive capabilities.

What prosthesis can be purchased, how long does it last? Zimmer manufactures the following implant structures:

knee replacement prosthesis. The undisputed leader: almost half of the operations are performed with the use of prostheses from this company. Service life - 15 and more years;
endoprostheses for replacement of the shoulder joint. Unique innovative development - a joint with a maximum level of implantability, restoring hand functions by 95%;
implants for hip replacement. Large selection of species, there is the possibility of individual selection, including the price.

The main difference between Zimmer products is the high adaptation of the prosthesis, which shortens the rehabilitation period.

cost of the hip joint

Fact: there is no specific prosthesis - a universal model that could fit everyone and not provoke side effects.

If you decide on arthroplasty, pay attention - the price of an implant, Zimmer or ceramic, has nothing to do with the success of the treatment. It makes sense to opt for an inexpensive but suitable orthopedic item for you.

Joint treatment More >>

Knee prosthesis. Materials used in hip arthroplasty Materials of the components of the endoprosthesis

Indications for hip replacement surgery

Myths about hip replacements

Myth #1: Hip surgery should only be done as a last resort.

Myth two: for a full recovery, you just need to do this operation

Myth three: the endoprosthesis quickly fails

Varieties of endoprosthetics

Replacement of surfaces of the hip joint

Partial arthroplasty

Total or complete dentures

Varieties of prostheses

Contraindications for the operation

How to continue to live after prosthetics?

How to choose the best hip replacement

Types of endoprostheses, their differences

Hip joint: prosthesis price

Where to buy a hip prosthesis?

Dislocation of the hip prosthesis

Zimmer: hip prostheses

cost of the hip joint

Indications and restrictions

What to consider when buying?

Types of endoprostheses, their differences

Hip joint: prosthesis price

Where to buy a hip prosthesis?

Dislocation of the hip prosthesis

Zimmer: hip prostheses

cost of the hip joint

How to forget about pain in the joints?

Indications and restrictions

What to consider when buying?

Manufacturing materials

Osteoporosis as a cause of unreliable fixation of the prosthesis

What to do after surgery

How to reduce wear

Revision operation

Who is the operation for?

Operation types

What are the designs

Fixation methods

Manufacturers and cost

The rehabilitation process

Reviews

Cost of hip arthroplasty | Dr. Yolkin

What determines the cost of a prosthesis?

Replaceable joint

Manufacturer

Materials of the components of the endoprosthesis

Fixation method

What determines the total cost of the operation?

Endoprosthetics of the hip joint - prices in the Moscow region | Found 1 price

Preparing for the operation

Endoprosthetics of the hip joint

Postoperative period

What can be called ideal?

Main manufacturers and cost

How to choose a surgeon

Hip replacement: surgery, choice of prosthesis

Indications for endoprosthetics

Endoprosthesis surgery

The cost of surgery and consumables

Rehabilitation after endoprosthetics

What is an endoprosthesis

In what cases is the replacement of the joint with an endoprosthesis indicated?

Classification of implants

Types of implants by their design

Types of implants according to the method of their attachment

Types of implants according to the materials of manufacture

Manufacturers of hip endoprostheses

Average cost of hip arthroplasty

How to choose an implant

Endoprosthesis installation technique

Types of endoprostheses, their differences

Hip joint: prosthesis price

Where to buy a hip prosthesis?

Dislocation of the hip prosthesis

Zimmer: hip prostheses

cost of the hip joint