Endoprosthesis replacement (arthroplasty) of the knee joint (complete replacement of the knee joint). Possible complications and postoperative period. Where is a knee replacement done?

It is carried out in such medical indications as:
rheumatoid arthritis,
hemophilia,
gout,

It is usually carried out under general anesthesia, when you are asleep during the entire operation, or under spinal or epidural anesthesia, when you are awake but do not feel anything in the lower body, starting from the waist.

However, there is a high chance that another operation will be required after this procedure, which is less common with total joint replacement. This means that this operation joint replacement less suitable for young active people and best suited for older, thin people who lead a less active lifestyle.

This is a radical surgery, and as with any surgery, there are a number of risks here too. The surgical risks of knee replacement include:

Infection of the wound - this is usually treated with antibiotics, rarely the wound is deeply affected and additional surgery may be required, even more rarely it may require complete removal of the knee joint,
- fracture or fracture of the bone around the artificial joint during or after surgery - treatment depends on the location and size of the fracture or fracture, excessive bone formation around the prosthesis, which limits the movement of the joint - additional surgery is required to remove excess bone tissue and restore joint mobility,
- the formation of excess scar tissue, and as a result, the limitation of joint mobility - during surgical intervention, excess tissue is removed and joint mobility is restored,
- displacement of the patella - restoration of its normal position is possible surgically,
- numbness, numbness around the scar,
- unexpected bleeding in the joint, and damage to the ligaments, arteries or nerves around the knee joint.

Somewhere after 50 years, a certain part of people begin to experience natural wear and tear of the joints, which, in medical terminology, is called osteoarthritis. Clinical manifestations of this disease are morning stiffness, pain, limitation of movement in the joints and their deformation. At the same time, in the same age period, patients develop osteoporosis - a disease that today can be considered a "silent" epidemic. With osteoporosis, bone tissue loses calcium and the bone becomes brittle, which means that the slightest injury can provoke a fracture in a patient. The danger lies in the fact that the patient does not have pronounced clinical manifestations of the disease. The main method for diagnosing osteoporosis is densitometry. If the study confirms the presence of osteoporosis, the patient is prescribed appropriate drugs that must be taken for life. But what if surgery becomes necessary?

It would seem that bones are bones, joints are joints ... However, it turns out that the successful result of a reconstructive and restorative operation to replace a joint directly depends on what environment the prosthesis or foreign body gets into, how healthy our bones turn out to be. By the way, surgical treatment of the first or second stages of arthrosis can slow down the further development of the disease by 8-15 years. The minimum cost of operations to replace a good level joint, with a joint made in the USA, is about three hundred thousand rubles. The same high-class operation costs about a million rubles in Moscow. What does high class mean? The operation is performed by a leading Israeli orthopedic surgeon who flies to Moscow every month. The operating room and the choice of prostheses are also top notch. An infectivity of about 0 is guaranteed, because in some centers it reaches 5-8%. This indicator is the most important, because infection of the joint leads to either long-term severe treatment or death. And you can have the operation abroad, for example, in Israel (cost from 25 thousand dollars).

Today, there is a certain queue for arthroplasty. For those who are indicated for joint prosthetics, experts advise not to waste time, but to seek help from a high-quality private clinic. The question price is too high, in case of an unsuccessful operation. So, three components are important: the qualification of an orthopedic surgeon, the correct selection of a prosthesis, and minimal infectiousness.

According to European data, one joint replacement surgery is required for every thousand of the population.

Do not put up with pain, start solving problems now - Joint replacement in Russia, Israel, Germany and the USA where is it better and how much does it cost.

Total hip replacement is a surgical procedure whereby diseased cartilage and bones of the joint are replaced with artificial materials. A normal hip joint can be represented as a hinge, where the head plays the role of a ball, and the acetabulum plays the role of a rosette (the anatomical name is "ink"). Simultaneous replacement of all structures of the joint includes surgical removal of both the affected femoral head and rosette with simultaneous replacement with a special endoprosthesis that mimics the hip joint. It consists of a metal artificial ball and an artificial cavity in which it slides. The endoprosthesis is installed using a special bone cement methylmethacrylate. In addition, it is possible to carry out prosthetics without the use of cement. In this case, the bone tissue grows from the adjacent areas into the micropores of the endoprosthesis. This option gives the best results, greater durability, it is preferable in young patients. Recently, minimally invasive hip arthroplasty has been increasingly used instead of the traditional one.

Who is a candidate for total joint replacement?

Most often, the operation is performed in patients with severe progressive arthritis and severe damage to the articular surfaces. More often it is degenerative osteoarthritis of the hip joints. This type of arthritis usually develops with age, but can also occur with congenital anomalies of the hip joint or after an injury. Other indications leading to total joint replacement include hip fractures, rheumatoid arthritis, and aseptic necrosis of the femoral head. Necrosis of the femur can be caused by a fracture, certain drugs (such as alcohol or prednisone and prednisolone), diseases (such as systemic lupus), and certain medical conditions (such as after a kidney transplant).

Progressive, intense chronic pain, together with deterioration in normal function (including walking, climbing stairs, and even standing up from a seated position) may ultimately warrant consideration for hip arthroplasty. Since endoprosthetics can potentially have unfortunate consequences, the decision to have surgery is not an easy one, especially for younger patients. Joint replacement may be justified when the pain becomes so severe that it interferes with normal function despite the use of anti-inflammatory and pain medications. Hip replacement is an elective procedure, which means that the operation is a choice among other alternative solutions to the problem. It is a decision that is made taking into account the potential risk and benefits. Careful weighing of both all aspects of the procedure itself and the expected outcome is an important part of the decision-making process.

What are the risks of the operation?

The risks of hip arthroplasty include blood clots in the vessels of the lower extremities with the possibility of blood clots traveling to the lungs (pulmonary thromboembolism). Serious cases of pulmonary embolism are rare, but can cause respiratory failure and shock. Other complications include urinary incontinence, local infection of the skin or joint, bone fracture during and after surgery, severe scarring and limitation of hip mobility, and weakening of implant attachment sites, which ultimately leads to failure. Since total joint replacement requires anesthesia, the risk of developing cardiac arrhythmias, toxic liver damage, and pneumonia must be added to the above risks.

What is the importance of preoperative assessment of the patient's condition?

The operation can lead to massive blood loss. Therefore, patients planning to undergo surgery often donate blood (autologous blood) to the blood bank in advance in order to receive their own blood back during the operation during the operation. In this way, possible complications from transfusion of donor blood can be minimized. Preoperative preparation also includes a review of all medications the patient is currently taking. Anti-inflammatory medications, including aspirin, are usually discontinued one week prior to scheduled surgery. The reason is the effect of these drugs on the function of platelets with a violation of normal blood clotting. They can be resumed after surgery. Before surgery, a complete blood count is performed, including electrolytes (potassium, sodium, chloride, bicarbonate), kidney and liver tests, urinalysis, lung x-ray, ECG, and a thorough physical examination. Any indication of infection, serious heart or lung disease, decompensated metabolic disorders (eg, uncontrolled diabetes) may require a postponement of the operation.

Joint arthroplasty is the replacement of a diseased or destroyed joint or part of it with an artificial implant - an endoprosthesis. Endoprosthetics of a diseased or worn joint not only allows the patient to get rid of pain, but also improves mobility in the joint. Joint replacement is an effective, and sometimes the only, way to restore joint function, which can significantly improve a person's quality of life. Modern endoprostheses are high-tech and made of materials that are as close as possible to natural human tissues. Joint replacement surgery has a high degree of efficiency. Also, the undoubted advantage of joint replacement surgery is the rapid recovery of patients. After one or two months, the patient can return to active life.

Who is eligible for hip arthroplasty?

Joint replacement surgery is most often performed for diseases and conditions such as:

Deforming osteoarthritis of the hip joint (coxarthrosis);
aseptic necrosis of the femoral head (ANGBK);
hip dysplasia
consequences of traumatic injuries of the hip joint
femoral neck fracture

Each diagnosis described above is not yet an absolute indication for surgery: in each case, this issue is resolved after a thorough examination and examination of the patient by the attending physician.

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

Knee prosthetics do not interfere with sports. After the knee replacement has been carried out, the patient very quickly returns to his usual way of life.

Indications and contraindications for knee replacement

Some diseases of the knee joint cause terrible inconvenience, and even torment to their owners. The pains are aggravated while walking and when the weather conditions change. The gait changes, mobility is limited, lameness appears. Knee replacement surgery is performed in patients with the following diseases:

Osteoarthritis (salt deposition);
rheumatoid arthritis (inflammation of small joints);
functional disorders of the limbs;
aseptic necrosis (necrosis of bone tissue);
previous injury.

Orthopedic surgeons are constantly improving their skills and gaining experience, as technology is constantly being upgraded. Analyzes and research in the field of prosthetics are carried out. The best modern materials are used. No matter how good the doctor turns out to be, and no matter how expensive the prosthesis is, there are contraindications to surgical intervention:

Severe form of diabetes;
developed rheumatism (lesion of periarticular soft tissues);
diseases associated with blood clotting;
cardiopulmonary insufficiency;
kidney failure;
malignant formations;
tuberculosis;
psychoneurological diseases.

As a rule, age itself is not a contraindication. In general, only a doctor will tell you whether it is possible to perform an operation, or whether there may be complications after knee replacement. After consultation and research, the orthopedic surgeon will select the prosthesis depending on what type of arthroplasty is needed: total or partial.

The operation itself

Before the operation, an X-ray examination is performed. To determine the degree and nature of the joint deformity, several pictures are taken in frontal and lateral projections. To obtain information about the anatomical and physiological state of the joint, arthroscopy is performed. An incision is made in the joint area and endoscopic equipment is inserted inside, which examines the joint from the inside. The study is highly informative, so it is often used for other operations, for example, when an elbow replacement is needed.

The artificial knee joint mimics the shape of the natural one. The operation itself takes about an hour and a half. Under anesthesia, an incision is made and the surface of the femur, tibia and patella is removed, then the prosthesis is fixed. The volume depends on the type of lesion, so sometimes only components are replaced, leaving the native articular apparatus. During the operation, measures are taken to exclude infectious complications and blood accumulation.

In the video on knee replacement, you can see schematically how this happens. The operation is quite common, and orthopedic surgeons do it even with those who limped for several decades and did not see a way out. As for the endoprosthesis itself, it is made of various materials and consists of three components: the tibial and femoral components and the patella. Compared to the previous generation, where everything was presented as a hinge fastened with a pin, today's prostheses last much longer. Previously, when walking, the element loosened, and the prosthesis simply fell out.

After the operation, an x-ray is immediately taken to check the correct position. The patient spends several hours in intensive care, after which he returns to the general ward. The next day the patient is allowed to move around. Next, a very important stage of treatment begins - rehabilitation after knee replacement.

Hospitalization is carried out a few days before the operation. During this time, the patient is examined by members of the anesthesia team. Most often, when arthroplasty of the knee joint is performed, general anesthesia is performed, that is, medical immersion in artificial sleep, as well as spinal or epidural anesthesia, in which the patient remains conscious, but the lower limbs do not feel anything. The method of anesthesia is determined by the anesthesia team after examining the patient during hospitalization.

The operation itself takes about two hours. During the operation, an orthopedic surgeon removes damaged bones and cartilage of the knee joint and replaces them with metal and plastic components of the endoprosthesis, which restores the function of the joint and the correct location of its elements.

Currently, a wide variety of materials and types of endoprostheses are used in total knee arthroplasty. Most of them consist of three components: a femoral component (made of highly polished, durable metal), a tibial component (made of durable plastic, which is often held on a metal liner), and a patella component (also plastic).

After the operation is completed, the patient is transferred to the intensive care unit, where doctors monitor his condition and recovery from anesthesia for some time. After stabilization of the patient's condition, they are transferred to the postoperative ward.

The purpose of this period of rehabilitation after hip replacement is to learn how to get out of bed, stand, sit and walk so that you can do it safely yourself. We hope that our simple tips will help you with this.

Already on the first day after the operation, in the absence of any complications, you can sit up in bed, leaning on your hands. On the second day, you need to start sitting up in bed, lowering your legs from the bed. This should be done in the direction of the non-operated leg, gradually moving the healthy leg and pulling the operated leg towards it. In this case, it is necessary to maintain a moderately spread position of the legs. To move the operated leg, you can use devices such as a loop of a towel, a belt or any dense fabric, as well as a crutch, etc. When moving the operated leg to the side, keep the body straight and make sure that there is no outward rotation of the foot. Sit on the edge of the bed with your operated leg straight and in front. Slowly place both feet on the floor. It is immediately necessary to remember that before you sit down or stand up, you must bandage your legs with elastic bandages, or put on special elastic stockings to prevent thrombosis of the veins of the lower extremities!

You are allowed to get up on the second day after the operation. At this time, you still feel weak, so in the first days, at the very beginning of the rehabilitation period after hip arthroplasty, someone must definitely help you, supporting you. You may feel slightly dizzy, but try to rely on your strength as much as possible. Remember, the faster you get up, the faster you can walk on your own. The medical staff can only help you, but no more. Progress is entirely up to you.

So, you should get out of bed in the direction of the unoperated leg. Sit on the edge of the bed with your operated leg straight and in front. Before you get up, check that the floor is not slippery and that there are no rugs on it! Place both feet on the floor. Leaning on crutches and on an unoperated leg, try to stand up. (Caring relatives or medical staff should help you in the early days). You can get up for the first time only in the presence of a physiotherapy instructor or a doctor. Leaning on a healthy leg, push the two crutches forward. Then transfer the operated leg to the level of the crutches, slightly bending in all joints. Leaning on crutches and transferring body weight to them, move your healthy leg forward. Repeat all movements in the same order.

When walking in the first days, you can only touch the floor with the operated leg. Then slightly increase the load on the leg, trying to step on it with a force equal to the weight of your leg or 20% of your body weight. You can walk for as long as your well-being, the condition of your leg allows, without reducing the time of therapeutic exercises. If you do not do enough gymnastics, incorrectly, abuse walking, the swelling of your legs will increase by the end of the day. In this case, seek clarification from your doctor. Concomitant diseases can support swelling of the legs.

The main goal of physical therapy for rehabilitation after hip arthroplasty is to improve blood circulation in the operated leg. This is very important to prevent blood stasis, reduce swelling, and speed up the healing of a postoperative wound. An important task of physical therapy is to restore the strength of the muscles of the operated limb and restore the normal range of motion in the joints. Remember that in the operated joint, the friction force is minimal. It is a swivel with perfect sliding, so all problems with limiting the range of motion in the joint are solved not with the help of its passive development by the type of rocking, but due to the active training of the muscles surrounding the joint.

In the first weeks after the operation, physiotherapy exercises are carried out lying in bed. All exercises should be performed smoothly, slowly, avoiding sudden movements and excessive muscle tension. During physiotherapy exercises, proper breathing is also important - inhalation usually coincides with muscle tension, exhalation with muscle relaxation.

Climbing and descending stairs

So, you walk quite confidently on crutches along the ward and the corridor. But this is clearly not enough in everyday life. Almost every patient has a need to walk up the stairs. Let's try to give some advice. If you have replaced one joint, then when moving up, you should start lifting from the non-operated leg. Using crutches, move your non-operated leg to the next step. Push off with crutches, transfer body weight to the non-operated leg. Then the operated leg moves - lift and place it on the same step. The crutches move last or at the same time as the operated leg. When descending stairs, the crutches should be moved first, then the operated leg, and finally the non-operated leg. Therefore, first place the crutches and the operated leg on the underlying step. Leaning on crutches, bend the non-operated leg at the joints and, maintaining balance, place it next to the operated leg.

If you have both hips replaced, then when lifting the first leg, the more stable leg starts to move, then, as described earlier, the less stable one and the crutches. When descending, the crutches should also be lowered first, then the weak leg, and finally the strong leg.

If possible, use a railing instead of one crutch. So, once again we repeat the general rules for moving up the stairs - a healthy leg is always on a higher step, a sore leg is always below, on a lower step. A cane or crutches are left for support on the same step with a sore leg.

In the future, avoid sudden movements, jumping on the operated leg. Walking, swimming, calm cycling and calm skiing, skittles, tennis are recommended.

Usually, with full restoration of limb function, patients have a desire to continue playing their favorite sport.

But, taking into account the peculiarities of the biomechanics of the artificial joint, it is desirable to avoid those types of sports activity that are associated with lifting or carrying weights, sharp blows to the operated limb. Therefore, we do not recommend sports such as horseback riding, running, jumping, weightlifting, etc.

If this does not contradict your aesthetic views and does not affect the attitude of others around you, use a cane when walking!

If you dance - then calm and slow dances. Forget squatting, rock and roll.

We advise you to make some simple devices to make your daily life easier. So, to avoid excessive hip flexion, when bathing, use a sponge or washcloth with a long handle and a flexible shower. Try to buy shoes without laces. Wear shoes with a long-handled horn. In some patients with a running process, certain difficulties persist when putting on socks. For them, we recommend using a simple device in the form of a stick with a clothespin at the end when putting on socks. Wash the floor with a long-handled mop. When traveling in a car, try to push the seat back as much as possible, taking a semi-reclined position.

And finally, I would like to warn against one more dangerous delusion. Remember that your artificial joint is not eternal. Of course, one should not constantly think about the inevitability of a second operation (especially since most patients manage to avoid it). But at the same time, repeated joint replacement or, as doctors call it, revision arthroplasty, is far from a tragedy. Many patients are terrified of a second operation on the joint, and endure the pain that has arisen, just not to go to the doctor. Keep in mind that “itself” will not go away, and it is necessary to inform the doctor about the discomfort that has arisen. Firstly, not all pains and discomforts in the joint require mandatory surgical intervention, and the sooner the doctor becomes aware of them, the more likely they are to get rid of them easily. Secondly, even with fatal loosening of the joint, an earlier operation is much easier for the patient and the surgeon and leads to a faster recovery. We hope that the artificial joint relieved you of the pain.

Before the operation, the doctor must inform you about the possible consequences after arthroplasty, what the rehabilitation period includes and how long it lasts. It takes a lot of effort and time, much more than the operation itself. A mobile and pain-free lifestyle depends on you no less than on the quality of the prosthesis and the skill of the doctor.

The type of prosthesis depends on the treatment that the orthopedist prescribes. The first days of classes are held under the supervision of medical personnel. They are not as intense as in the subsequent period. Basic exercises are suitable for all patients:

Stop movement on yourself;
movement of the feet away from you;
tension of the quadriceps muscles, indentation of the knees into the floor (bed).

All exercises are performed at half strength for 2-3 seconds. Be sure to do breathing exercises:

straighten your posture;
expand the chest as much as possible, otherwise deep breathing will not work;
straighten the neck to improve blood circulation;
take a long breath;
take a long breath.

It is necessary to accustom yourself to breathe not superficially, but deeply. Proper breathing also promotes relaxation. In reviews of knee replacement, you can find complaints of decreased appetite after surgery. In order for the wound to heal and the muscle to grow stronger, it is necessary to adhere to a balanced diet.

Until complete healing, the suture wound must be protected from getting wet and rubbing against clothing, from falling. A postoperative bandage should be worn. And most importantly, physical activity. From the first days, non-aggressively and calmly, it is required to return the usual skills of everyday life. When knee flexion is restored, you can even drive a car.

Complications after knee replacement

The doctor must inform the patient about all possible complications after prosthetics. Not for the purpose of insuring, but in order to, foreseeing, try to avoid them and minimize the risk.

Postoperative infections are possible. A course of antibiotics is taken to prevent it. And the patient cares for the wound, as described above. People with diabetes should be especially careful. Today, this complication is very rare.
More often, thrombosis occurs - the formation of a blood clot in the veins of the leg. To improve blood flow, exercise regularly, wear compression stockings, and take blood thinners.
As good as dentures are, they eventually wear out and components fall out. Their longevity depends on the quality.

Everything is carefully discussed with the doctor on the eve of the operation, and the prescriptions are followed without a single deviation.

The hip replacement surgery takes approximately two to four hours of the surgeons' time. Preparing for surgery may take additional time. After the operation, the patient is transferred to the recovery room for continuous observation, which usually lasts from one to four hours. The lower extremities are carefully examined to determine the state of circulation and sensitivity in them. If the patient experiences unusual symptoms of numbness or tingling, the recovery room nurses should be notified immediately. After stabilization of the patient's condition, the patient is transferred to the regular fee.

During the early recovery period, the patient is given intravenous fluids and antibiotics. Intravenous fluids are important for maintaining the body's water-salt balance. The patient will also see special drains installed in the postoperative wound, which drain the discharge from the surgical wound. The amount and characteristics of discharge from the wound are very important for their evaluation by the doctor. Therefore, the nurse pays careful attention to them when visiting the patient. The bandage is applied in the operating room and remains for 2-4 days, after which it is changed by the surgeon and nurse.

Pain medications are often administered using a dedicated patient-controlled pump (PCA), whereby patients can truly control the dosages of the medication as they feel. Pain medications can sometimes cause nausea and vomiting, so medications are sometimes needed to relieve them.

Measures to prevent pulmonary embolism. The lower limbs are placed in special elastic cuffs (TEDs) after the operation. Additionally, compression stockings can be used, which have a compressive effect due to the circulation of air in plastic cavities wrapped around the leg. The patient is advised to perform exercises with the lower extremities to mobilize venous blood and prevent thrombosis. Some medications are also used to reduce the risk of developing phlebothrombosis.

Patients may experience difficulty urinating as a side effect of anesthesia medications. As a result, a catheter is often temporarily placed in the bladder to restore normal urine flow.

Immediately after surgery, the patient will be asked to breathe deeply and cough in order to avoid congestion in the lungs and blockage of the small alveolar airways. In this case, special devices are often used that increase resistance to breathing and coughing, increasing air pressure and helping to open collapsed airways.

What is the rehabilitation after arthroplasty?

After the hip replacement surgery, physiotherapy exercises are prescribed immediately. On the first day after the operation, therapeutic exercises are prescribed in a sitting position. In the end, gradually the patient begins to step on his feet, walk and climb stairs. Assistive devices (e.g. crutches) are used initially. During exercise therapy, the appearance of pain is monitored. Some discomfort should be considered normal. Patients are often rewarded very early on with almost no joint pain they had before surgery.

Therapeutic exercise is extremely important to improve the results of any joint replacement surgery. The goals of exercise therapy are to prevent contractures, teach patients how to move correctly, and strengthen the muscles around the joint through controlled exercise. Contractures may occur as a result of scar tissue around the artificial joint. They can severely limit the range of motion in the joint. Patients are instructed how to behave at home: not to overload the operated leg with a large range of motion or any unusual movements. Special devices for giving the body a certain position or seat, elevating toilet seats are often very useful. Patients are instructed not to bring the leg past the midline (cannot cross the legs) due to the risk of joint dislocation. For the same purpose, while lying on your side (from the side of the non-operated leg), a pillow should be placed under the upper (operated) leg. For exercise therapy at home, the patient is given a set of exercises to strengthen the muscles in the circumference of the hip joint. Often, patients visit an exercise therapy instructor during the recovery period until exercise becomes part of their normal daily routine.

Occupational therapy is also part of the rehabilitation process. Specialists conduct an audit of the patient's daily activities and develop precautionary measures. They also teach patients how to use adaptive equipment that helps the patient adjust to daily life.

What other instructions will the patient receive after the operation?

The patient will be advised to continue using the special devices (such as a walker or crutches) that were recommended by the doctors. You may be advised to continue taking anti-clotting drugs (eg, warfarin, aspirin). Sometimes heparin preparations are prescribed in the form of injections. In some cases, painkillers, sleeping pills, and drugs to relax (relax) the muscles are prescribed.

Gradually, patients become more confident and less dependent on assistive devices. Patients should be alert for possible signs of infection, including swelling, fever, redness, or increased pain at or around the surgery site. The patient should notify the doctor immediately if these signs occur. The postoperative wound is usually regularly examined by the attending physician. Stitches are usually removed a few weeks after surgery.

Surgery to replace the knee joint is performed in some cases. This operation is common among patients whose knee joints are damaged by osteoarthritis. As a result of this disease, the knee cartilage becomes thinner, coarsens, and in some places is completely worn out.

In addition, bone growths can form on the surface of the joint, as a result, the bones "rub" against each other. This causes pain, swelling, and limited mobility in the affected knee.

Other medical indications for knee replacement include:

Rheumatoid arthritis,
hemophilia,
gout,
disorders that cause abnormal growth of bone tissue (bone dysplasia),
impaired blood supply and necrosis of bone tissue in the knee (avascular necrosis).

In addition to the listed medical indications, the need for knee replacement may be caused by an injury or deformity of the knee.

Modern knee replacements involve removing the worn parts of the bone in your knee joint and replacing them with metal and plastic pieces.

Knee replacement surgery is usually performed under general anesthesia, where you are asleep during the entire operation, or under spinal or epidural anesthesia, where you are awake but do not feel anything in the lower body, starting from the waist.

The operation usually takes one to three hours. Sometimes a nerve block is used along with anesthesia, this block relieves pain in the leg within 36 hours after surgery. During the operation, many surgeons apply a tourniquet to the thigh. This reduces bleeding in the knee and makes the operation easier.

The knee is opened with a long incision and the patella is exposed. The patella moves, exposing the knee joint located behind it between the tibia and femur. All bony growths are removed and the tension on the soft tissues is released so that the knee returns to its natural shape. Damaged parts of the bones are cut off. This is done with great precision so that the precisely fitting artificial joint (prosthesis) components can cover the worn cartilage. The lower end of the femur is replaced with a single anatomically adapted steel prosthesis. A flat plate made of steel or titanium replaces the top of the tibia. Plastic inserts are attached to the plate allowing the bones to move easily. Plastic liners are made of polyethylene and are therefore strong and smooth. Thanks to the combination of metal and plastic, the joint has a low coefficient of friction.

Once your bone has been measured and prepared, a mock prosthesis is placed and the joint is tested for stability and correct movement. Then it is finally adjusted, the ends of the bone are cleaned and the prosthesis itself is already set in place, fixing with a special bone cement, or using cementless “press-fit” fixation. The wound is then sutured and bandaged. They can also apply a splint to keep the leg motionless.

After surgery, antibiotics may be prescribed for a while to prevent infection and pain medications are given to relieve pain.

If only one side of the knee is affected, a partial knee replacement (unipolar knee replacement) is possible. This is a more gentle procedure than a total joint replacement and involves a faster recovery period.

However, there is a high chance that another operation will be required after this procedure, which is less common with total joint replacement. This means that this operation is less suitable for young active people and is best suited for older, thin people who lead a less active lifestyle.

Knee replacement is a radical surgery, and as with any surgery, there are a number of risks. The surgical risks of knee replacement include:

Infection of the wound - this is usually treated with antibiotics, rarely the wound is deeply affected and additional surgery may be required, even more rarely it may require complete removal of the knee joint,
fracture or fracture of the bone around the artificial joint during or after surgery - treatment depends on the location and size of the crack or fracture, excessive bone formation around the prosthesis, which limits the movement of the joint - additional surgical intervention is required to remove excess bone tissue and restore joint mobility,
the formation of excess scar tissue, and as a result, the limitation of joint mobility - during surgical intervention, excess tissue is removed and joint mobility is restored,
displacement of the patella - restoration of its normal position is possible surgically,
numbness around the scar
unexpected bleeding in the joint, and damage to the ligaments, arteries, or nerves around the knee joint.

In some cases, the knee joint may remain unstable and additional surgery will be required to correct it. For six weeks or more after surgery, blood clots (thrombosis) can form in the veins of the leg, causing pain and swelling. Blood clots are treated with blood thinners and are usually not a problem, but about one in twenty people experience pain and swelling. Very rarely, a blood clot can reach the lung and block a blood vessel (pulmonary embolism), in which case immediate medical attention is required.

As a rule, after a knee replacement, pain may be disturbing. Most patients who have undergone knee replacement surgery note that the postoperative pain is moderate and cannot be compared with the pain they endured before the operation. The pain responds well to medication and gradually resolves over several months.

Immediately after surgery, you will be given pain medication. A day after the operation, a physiotherapist will meet with you to explain what exercises to do in order to speed up recovery.

A physiotherapist will observe and control the recovery process, show you exercises for the knee so that it recovers faster. To restore motor function in the knee and leg, a physiotherapist can use the CPM (long-term passive movement) knee rehabilitation system. This system supports the knee, moves it slowly while you are in bed, reduces swelling by keeping the leg up, and improves circulation by moving the leg muscles.

Walking with a frame or support is recommended; over time, they are replaced by a cane. Many people start walking independently with a cane after about a week. The wound remains closed and requires regular bandaging until complete healing. The stitches or staples will be removed a few weeks after surgery.

Depending on the recovery process, most people leave the hospital after 7-10 days. Walking with a cane is recommended for a period determined by the doctor after discharge from the hospital (usually about 6 weeks after surgery). The physiotherapist will continue to give advice on working out the knee.

The exercises recommended by the physiotherapist are a key part of rehabilitation, so it is very important to do them. A typical rehabilitation program includes small walks to improve mobility, routine housework, sitting and walking up and down stairs, and special exercises performed several times a day to restore mobility and strengthen the knee.

Depending on the progress, the normal life that you led in your free time is possible between the third and sixth weeks after the operation. It can take more than three months before the pain stops and the swelling subsides, and your knee will continue to recover for about two more years if you work on it further and continue to do the recommended exercises. Follow-up is to check every two years.

Driving can be resumed when the knee can flex enough to easily get in and out of the car and when sufficient muscle control is restored for normal driving. Most people are able to drive as early as 4-6 weeks after knee replacement.

Total hip replacement (arthroplasty) is one of the most successful orthopedic surgeries to date. For patients suffering from pain in the hip joint due to various reasons, this operation allows you to get rid of pain, restore mobility in the joint and improve the quality of life. The founding father of hip arthroplasty is Sir John Charnley, a British orthopedist who developed the fundamental principles of the operation. He invented the hip prosthesis in the late 60s of the 20th century, which is still in use today. Every year, about 500,000 hip replacement surgeries are performed worldwide. Normally, the hip joint is a ball-and-socket joint. The ball-shaped upper part of the femur is attached to a part of the pelvic bone called the acetabulum, which allows smooth movement in the joint in different planes. The most common cause of dysfunction of the hip joint is osteoarthritis (osteoarthritis, osteochondrosis). Other possible causes are inflammatory diseases of the joints (rheumatoid or psoriatic arthritis), congenital diseases, and the consequences of trauma.

Indications for hip replacement. Hip arthroplasty is indicated only when other treatments have not been successful and have not resolved the problem of pain, stiffness, and joint dysfunction. It should be taken into account that the prosthesis wears out over time, and therefore doctors usually advise to postpone the operation until it becomes absolutely necessary.

Alternative treatments. While hip replacement can be very successful, it is important to discuss individual characteristics, possible complications, and alternative treatments with a specialist before deciding on surgery.

non-surgical treatment. For patients with various hip disorders, non-surgical treatment is usually recommended first, which includes: Weight loss or maintenance of normal weight Physical therapy Use of assistive devices (cane, walker) Pain medication Intra-articular injections of glucocorticoid (steroid) drugs Patients with rheumatoid arthritis require constant antirheumatoid and anti-inflammatory drugs.

Surgical alternative treatment. There are several alternative surgical methods for hip arthroplasty. Arthrodesis (fixation of the joint) or osteotomy may be recommended for young patients when the prosthesis has not lasted long enough and joint replacement cannot provide an active lifestyle for many years. Articular cartilage replacement is another method used in young people. The choice of surgical procedure is individual and depends on the cause of the joint disease.

Total hip arthroplasty is performed in the operating room under general, spinal or epidural anesthesia. Traditionally, one incision is made along the outer surface of the femur and thigh. Sometimes less invasive methods are used that allow for small incisions and require the use of special instruments. The type of prosthesis is selected individually for each patient, depending on the characteristics of his disease and the preferences of the surgeon. There are various types of prostheses with different surfaces, including metal-plastic, metal, ceramic-ceramic. Each surface has its own advantages and disadvantages, which should be discussed with the surgeon before surgery.

postoperative period. After surgery, the patient usually receives pain medication intravenously or by mouth. The patient also receives antibiotic treatment (usually within 24 hours after surgery). Blood thinners such as low molecular weight heparin (Clexan, Fragmin) are used to prevent blood clots in the lower extremities. For the same purpose, compression boots (devices that are placed around the leg and periodically inflated) or special compression stockings are used.

Rehabilitation. Physical therapy is an important part of the recovery process. Most people can try standing up and even walking, with the help of a physical therapist, during the first 24 hours. The length of hospital stay depends on a number of factors, although most patients stay in the hospital for 4-6 days. During this period, together with a physiotherapist, an exercise and rehabilitation program is drawn up. You can continue treatment at home under the supervision of a physiotherapist or stay in a rehabilitation center and continue physical therapy until you become independent in your daily life. The rehabilitation program usually includes stretching and strengthening exercises for the muscles surrounding the hip joint. In addition, it is necessary to train daily activities - walking, tilting, climbing stairs. The purpose of the rehabilitation period is to restore strength and range of motion in the joint. After several months of rehabilitation, an active lifestyle will be recommended to you. Most people can return to their normal activities within three to six months. Heavy sports activities (running, contact sports) and are not recommended after hip replacement, you will be able to walk, swim, ride a bike. The lifespan of dentures is usually 10-15 years and most people are very satisfied with the results. New types of prostheses will be able to withstand a longer time.

Complications. Serious complications after hip replacement are rare, and their likelihood can be further reduced if the operation is performed by an experienced and regularly operating surgeon, and the operation is performed in a medical center with extensive practice in managing such patients before, during, and after the operation. Complications can occur during, immediately after, or many years after surgery. It is important to have a clear understanding of the likelihood and significance of these complications before deciding on surgery. For most patients, the benefits of reduced pain and improved joint function outweigh the small risk of complications.

Complications during surgery occur extremely rarely. They include fractures (usually a fracture of the femur), damage to vessels or nerves in the area of ​​the operation. Most of these complications can be corrected during surgery.

Thrombus formation. Patients after hip replacement surgery have an increased risk of blood clots. With proper preventive treatment, the likelihood of blood clots is reduced
i to 1%. Low molecular weight heparin preparations (Clexan) are commonly used. Recently, drugs in the form of tablets have also appeared (Pradaxa, Xarelto).
Infection after hip plasty is rare (about 0.4 -1.5% of patients). After surgery, routine antibiotic treatment is given to prevent infection.

Dislocation an artificial joint can occur if the ball part comes out of its socket. This complication occurs in less than 2% of patients. In most cases, the orthopedist can set the joint back into place after the administration of sedative and pain medications. To reduce the risk of dislocation, the patient is instructed to limit certain movements in the joint. Limitations depend on the type of joint and should be discussed with the orthopedist.

Release of the prosthesis occurs mainly due to the wear of its parts. This is the most common long-term problem associated with joint replacement. The number of patients with such complications is decreasing as new materials and types of prostheses are developed and introduced.

Fracture of the prosthesis can occur due to wear, usually after many years. Old types of dentures are more prone to breakage, new types are much stronger and more durable. This complication occurs very rarely - in less than 0.5% of cases.

Change in leg length. Before, during and after surgery, careful measurements of the length of the legs are taken to keep them of equal length. However, occasionally, as a result of the operation, one leg becomes longer than the other. Some patients with a significant difference in leg length are helped by the use of a shoe insert.

stiffness joint is caused by excess bone formation. This is a process where part of the soft tissue around the hip joint undergoes ossification. Patients with this problem experience stiffness in the joint, and may not feel any discomfort.

Therapeutic and diagnostic sanation arthroscopy is a modern type of surgical treatment. This operation belongs to high-tech minimally invasive interventions. Arthroscopy is a study of the joint under the control of a video camera and micro-instruments that are inserted into the joint through mini incisions no longer than 1 cm. Such incisions heal quickly, the function of the joint is restored earlier, and the risk of infectious complications is significantly reduced. During the operation, the doctor has the opportunity to examine the cavity of the affected joint, remove the destroyed cartilage, adhesions in the joint, pieces of cartilage lying freely in the joint cavity (the so-called "chondromic bodies"), outgrowths of cartilage and bone tissue that limit joint mobility and cause pain , plentifully wash the joint cavity. After the operation, the range of motion in the joint is restored.

Endoprosthetics of the ankle joint (endoprosthesis)

Endoprosthetics of the ankle joint (endoprosthesis) is a complete replacement of the ankle joint with an artificial one. This is a complex, high-tech operation, with the success of which a person forgets about problems with the ankle joint for many years. During the operation, the surgeon completely removes the articular surfaces of the talus and tibia, and replaces them with metal implants coated with a polymer material. The polymeric material has a low coefficient of friction and ensures the sliding of the articular surfaces. The range of motion in the joint is complete.

Creation of arthrodesis

Creation of arthrodesis - operational immobilization of the ankle joint. During the operation, the articular surfaces of the ankle joint are removed, the treated surfaces of the tibia and talus are compared, and they are fixed. After 4-6 months, complete fusion of these bones occurs. After the operation, the pain in the ankle joint stops. Movement in the joint becomes impossible. However, the range of motion is partially compensated for by other joints of the foot, which does not lead to a significant impairment of the function of the limb as a whole.

Treatment of post-traumatic deforming arthrosis is a difficult task. But it can be successfully solved under the condition of joint and painstaking work on it by the doctor and the patient.

The hip joints are one of the largest joints in the human body. The hip joints connect the legs to the body. The hip joints are heavily loaded. An injured and diseased hip joint brings great suffering to a person.

The hip joint consists of the pelvic bone, acetabulum, femoral head and femoral neck. Along the edges of the acetabulum is, strengthening the hip joint, the acetabular lip (cartilage).

Inside the acetabulum is the head of the femur, connected by a neck. Below the neck of the femur - large and small skewers, femoral and gluteal muscles.

Strengthen the hip composition of the ligament of the joint capsule. The head of the femur is covered with articular cartilage, which allows it to glide smoothly. The spherical surface of the head allows for circular rotation of the thigh.

The articular cartilage between the bones plays an important role as a shock absorber when walking, jumping, running. Cartilage breakdown exposes bones. This results in severe pain and limits movement.

There are several reasons leading to the destruction of cartilage:

Injuries and bruises of the hip joint
Bone erosion (osteoarthritis thins cartilage)
Rheumatoid arthritis, gout and other systemic diseases
Autoimmune diseases
Lack of collagen, etc.

Cartilage erosion affects about 80% of patients under the age of 65 years. Drug treatment can only relieve pain, but cannot help stop erosion.

A thin, smooth tissue called the synovial membrane begins around the round ligament in a fossa on the head of the femur. The synovial membrane envelops the round ligament, reaches the acetabulum, passing to its bottom, covers the fat pad. It passes from the acetabulum to the inner surface of the fibrous bag and from it to the femoral neck, forming a transitional fold, reaches the beginning of the cartilage.

Generally, all components of a joint work together and produce a smooth movement. But due to the fact that the hip joint experiences a large weight load of the whole body when walking, running, carrying heavy loads, it wears out, is exposed to various risk factors and diseases.

The causes of damage to the hip joint are:

Injuries and bruises, fractures of the femoral neck
Necrosis of the femoral head
Inflammation of the joints (infectious complications)
Hormonal changes
Diabetes
Joint overload
Complete destruction of the femoral head
Worn out cartilage
Dysplasia (congenital deformities of the hip joint)
Arthrosis and arthritis of the hip joint
Overweight
Osteoporosis
Metabolic and circulatory disorders
Systemic diseases
Chronic stress, etc.

Hip problems can occur at any age. Pain in the hip joint can be caused by serious neurological diseases of the spine, inguinal hernias and pathological processes in the abdominal cavity.

When conservative treatment fails, painkillers, physiotherapy and each step causes unbearable pain, for example, due to arthrosis of the hip joint, fracture of the femoral neck or damaged cartilage, then it is recommended to replace the damaged hip joint.

Endoprosthetics of the hip joint restores the lost ability to move painlessly - restores the function of the limb.

Should I change the hip joint?

More than 90% of patients are satisfied with the results of hip arthroplasty. They had the opportunity to move freely, lameness completely disappeared, pain in the joint was eliminated, and there was no need to use additional supports.

After completing a full course of rehabilitation after arthroplasty, patients will be able to move independently: walk, swim, play golf, even ride a bike. It is important to remember that joint replacement, especially if it is associated with arthritis, will not allow you to play hard sports, run, ski and jump. The artificial joint has a limited range of motion compared to a healthy hip joint. But in everyday life, simple movements and walking without pain and crutches significantly improve the quality of life. Hip joint implants are designed for 15-20 years of operation. After this period, the endoprosthesis is replaced.

Models of hip endoprostheses are constantly updated. Currently, there are about 70 types of different designs. The success of arthroplasty depends on the strict implementation by patients of the doctor's recommendations and a special rehabilitation program. The patient is given instructions on how to exert dosed loads on the operated leg with physical exercises. How is endoprosthetic surgery performed? Endoprosthetics is the most common method of hip replacement.

This complex, high-tech arthroscopic minimally invasive operation requires the skill of an orthopedic surgeon and his assistants. Depending on the nature of the joint lesion, the orthopedist decides which type of endoprosthesis design to use for each specific patient. Before the operation, the general state of the patient's health, the causes of joint disease, etc. are studied. The operation of hip arthroplasty lasts from 2-3 hours. The patient lies on his side. The leg is bent and fixed to the table. The first stage is the preparation of access to the joint. A longitudinal incision 15-20 cm long is made along the joint. A very important step.

Modern technology allows you to minimally injure muscles and tissues. This will further help to quickly restore the motor functions of the limb. During the operation, the orthopedic surgeon removes damaged bones, joint cartilage, etc. with special minimally invasive instruments. Bone structures are prepared for implant placement. The second stage is the installation of an artificial prosthesis. The endoprosthesis, depending on the problem, can be metal, ceramic or plastic, or a combination. The prosthesis consists of a stem, a head, a cup and an insert. Each of them has its own size. First, a metal rod is inserted in the center of the upper part of the femur, then the head and insert, which provide movement. An orthopedic surgeon adjusts the head, checks the length of the limb, the range of motion, etc.

He selects and installs (according to size) the endoprosthesis. A friction unit is selected (from what material the prosthesis will be made). After initial fixation and checking the length of the limb, the prosthesis is fixed. The endoprosthesis of the hip joint is fixed with a special surgical bone cement or a special substance (without cement) that adheres to the bone. Sometimes two joints (hip and knee) are replaced in one operation. The third stage is the final one. The wound is thoroughly washed with antiseptics and the tissues are sutured in layers. Stitches or special staples are applied.

Why are the reviews of those who have undergone knee arthroplasty so different? The fact is that when it comes to the hip joint, everything is relatively simple, and the results are almost always positive.

• Types of endoprostheses
• Endoprosthesis surgery
• The rehabilitation period after arthroplasty

But it is difficult to prosthetize the knee, and more often there are complications:

• infection of the endoprosthesis area,
• dislocation of the prosthesis
• tearing of the patellar ligament,
• thrombosis of the veins of the leg,
• fracture of the femur.

For the sake of truth, it should be said that these cases are isolated, but taking place 10 years ago, and today there are much fewer complaining patients. All complications have an anatomical and biochemical feature. To date, the design of the endoprosthesis itself and the technology of the operation minimize the percentage of subsequent complications. But even the most successful work of the surgeon requires competent rehabilitation during the recovery period.

Types of endoprostheses

Endoprostheses of large joints, including the knee joint, are becoming more and more accessible. Due to frequent operations. This artificial product is placed in the body to replace a worn or damaged organ. Sophisticated endoprostheses made of quality materials that have passed numerous tests, trials and studies are more expensive than their Chinese counterparts.

When the entire knee joint is replaced, they talk about total arthroplasty. Sometimes a partial replacement of a department is enough. The materials from which the prosthesis is made depend on the manufacturer: durable plastic, metal alloy, ceramics. It is fixed to the bone with acrylic bone cement. The surgeon determines which type of endoprosthesis is right for you, as there are more than 150 models of implants on the market.

Modern implants take into account all the nuances and features of the structure of the knee and do not represent, as before, just a hinge. Recent studies have shown that male and female knees have differences, therefore, gender is also taken into account in the design and design. When choosing a model, the patient's age, weight, general condition, degree of activity, and cost are important. In some clinics, an individual prosthesis is made.

Endoprosthesis surgery

Usually implantation lasts 2-3 hours. Be sure to prevent infectious complications. Before installing the endoprosthesis, the destroyed parts of the knee joint, the back of the patella are removed and the axis of the leg is aligned. If necessary, the surgeon can restore the integrity of the ligaments of the knee joint.

To date, high-quality prostheses allow you to bend your leg up to 155 degrees. People wrote in the reviews that after the operation, before discharge, they already flexed the knee 75 degrees. But there is still a rehabilitation period ahead, which is no less important than prosthetics itself. Often, when there are reviews about complications after knee arthroplasty, it becomes clear that a big mistake was made in the postoperative period.

It is worth saying that spinal anesthesia is done before the operation. Judging by what eyewitnesses say, the sound that accompanies the whole thing is not very pleasantly tolerated, so if the anesthesiologist does not mind, you can ask for "sleep." Courage is needed in order to decide on the operation, and the attitude and patience will be required during recovery.

The rehabilitation period after arthroplasty

All patients who have undergone knee arthroplasty write about how effective recovery measures are. For some, it takes 2 months, for others, six months. But the result is almost always positive. The main thing is to work tirelessly on your renewed knee.

It is worth starting to fight for recovery on the first day. The main stage is the exercises that must be done in the morning, afternoon, and evening:

• raising a straightened leg;
• bending the knee with support on the bed;
• bending the knee while sitting without support;
• bending the knee while sitting with the support of a healthy leg;
• straightening of the knee joint;
• ankle rotation. Working leg muscles contribute to the normalization of blood circulation.

A set of exercises and their duration is determined by the doctor individually for each. Some have been impressed by a special device for passive flexion and extension of the knee, the use of which is called mechanotherapy. In mechanotherapy for physical exercises, specially designed mechanisms and apparatus are used.

It is very important to learn to walk with the help of a walker or crutches. So you can feel like a truly complete person. Try to take care of yourself, without outside help. Move walkers or crutches near the body and step on the heel of the operated leg, and then on the entire foot, after which you can tear off the big toe of the healthy leg from the floor. Over time, patients switch to a cane.

New knee, new steps, new movements, new life - this is what awaits a stubborn and obedient patient. As for the effect of joint arthroplasty, one thing is clear - everything is good that brings relief to the patient.

Reviews of doctors and patients about knee arthroplasty

Endoprosthesis replacement of the knee is performed in violation of the integrity and functional ability of the structures of the joint. Reviews about the procedure knee arthroplasty among patients and doctors there are different. However, under the condition of high professionalism of doctors and the use of high-quality prostheses, as a rule, the result of the operation is a significant increase in the quality of life of the patient.

Consider the reviews of patients who have decided to perform such an operation, and the opinion of doctors about knee arthroplasty as a method of treating degenerative-destructive pathologies of the knee.

Patient reviews

“Whatever the manufacturers of various “miracle remedies” promise to restore the integrity of the joint elements, it should be understood that the knee will not become healthy again from medications alone. I was convinced of this fact by the example of my husband.

He was diagnosed with arthrosis of the knee more than 10 years ago. During this time, they tried a lot of different methods of treatment, even turned to specialists in Chinese medicine. However, the effect after any of these methods lasted no more than six months, then pain reappeared. We decided to have surgery. Now my husband walks on his own and does not experience wild pains. The rehabilitation period was long and difficult, but all our efforts have now been rewarded.

“I have had painful joints for about 12 years. Only 3 years ago, knee arthroplasty was proposed, since their deformity was already too pronounced, and there was practically no flexion. It is worth noting that I was almost denied an operation, since a positive effect was possible, according to doctors, only in 10% of such cases. However, I still managed to find specialists who agreed to operate on me. The result exceeded all my expectations. Now I can live a full life without crutches and without pain.”

Valentine

“I changed my knee joint three months ago. I walk almost normally, I almost don't even use a cane. However, when walking for 10-15 minutes, I begin to limp a little, there is a slight pain that radiates right up to the waist. The doctor said that this is normal for this period after the operation. I went through rehabilitation together with people who did endoprosthetics abroad. The only significant difference for me is that the rehabilitation period begins earlier abroad, which allows you to recover faster.”

“We had an arthroplasty about 3 years ago. The volume of movements, of course, increased somewhat, the pain disappeared. I can’t say that my life has now become completely normal, but there is definitely an improvement in its quality. Of course, this operation will not return your former youth, but it will at least allow you not to be a burden for your family and friends. In addition, in our time there is an opportunity to join the queue for free knee arthroplasty, for those who cannot pay for this treatment on their own.”

“My mom had knee replacement surgery about 6 years ago. Everything was fine, there was no pain, she could even walk normally.

However last year suppuration in a joint has turned out. Next, surgery was performed to sanitize him, and a three-month course of antibiotic therapy was prescribed. Then a fistula appeared, about which another intervention was carried out. The prosthesis was removed. The bones of the femur and lower leg were fixed with the Elizarov apparatus for more than six months. There were no movements in the knee on the operated leg. The doctor says that we still got off lightly, as it could have ended in amputation.

“I changed both knee joints. The first operation was done about 11 months ago, and the second - after 6.5 months. I want to say that the doctor predicted the recovery of the leg after the operation no earlier than 12 months after the operation. However, I do not feel any reminders of the first operation. The second leg limps a little and gets tired, but the pains practically do not bother (only slight discomfort with prolonged stress on the joint). The terms of rehabilitation entirely depend on the patient himself and the qualifications of his mentor.”

Svetlana

“The operation to replace the left knee joint was done about 1.5 years ago. At first I had to walk with a walker, then with crutches. However, just a few months later she was able to move without support (at least indoors). Joint surgery is perhaps the easiest thing that awaits the patient on the way to a normal life. A lot of effort was spent on the rehabilitation period. However, I would like to note that the one who really experienced all the torments of arthrosis of the knee, all this will definitely pass.

Victoria

“A successful operation is only half the success. Even with an ideal operation, it is impossible to get a good result without the patient's active work on himself. Early exercise therapy will allow you to quickly and efficiently recover after such a complex intervention.”

« I had a knee arthroplasty about 8 years ago. Everything was fine, the operation and the rehabilitation period went well. After the operation, she was able to refuse such a number of painkillers that she had taken before (by pressing). However, recently she began to feel aching pain in the area of ​​the operated joint. I need to be examined again, but I'm postponing everything, because I'm afraid that they will find the instability of the artificial joint. This diagnosis involves the removal of the prosthesis. I read somewhere that an implant can take root only once. I’m not ready to give up life with an artificial joint yet.”

“I am only 27 years old. However, at her age, she managed to replace both knee joints with artificial prostheses. For a long time, she did not dare to have surgery on her knees, as she was afraid of complications and consequences. However, walking on half-bent legs is also not fun. I decided that if you already live, then you need to choose something that will make my life full, at least for a while. Yes, arthroplasty is a complex procedure and quite risky, but in order to walk like a person, it is worth the risk. I am satisfied with the operation, there is no pain and I walk smoothly.”

“The decision to undergo knee arthroplasty should be made by the patient after carefully weighing all the pros and cons of the procedure. You should not resort to the procedure in the early stages of the development of the disease or with the appearance of pain in the joint. As my doctor said, you should endure as long as you endure. Surgical intervention on the knee joint should be resorted to only if other methods of treatment are ineffective. The time has come for me to decide on this procedure. It's been 8 months since then. I feel much better, I walk almost normally, and most importantly, the pain does not bother me at all. ”

Stanislav

“Knee arthroplasty for many is an excellent solution to the problem of a diseased joint. However, the cost of this procedure is too high for the average resident of our country. The number of surgical interventions on the knee with the replacement of the joint or its elements according to the quota is also strictly limited. Quite often, you have to wait a long time for your turn for knee replacement surgery. For a patient with arthritic changes in the joint (I know from my own experience), such an expectation is accompanied by pain and sleepless nights.”

Reviews of doctors

“The knee joint is one of the most complex structures of the musculoskeletal system. That is why knee prosthetics is a more complex procedure than the operation to replace the hip or any other human joint. Given the anatomical features of the knee, this operation may be accompanied by such complications as: thrombosis, hip fracture, infection, violation of the integrity of the ligamentous apparatus, dislocation of the artificial joint. For this reason, this procedure should be resorted to only if other methods of treating pathologies of the knee joint are ineffective.

“Arthroplasty is a cardinal way to treat degenerative pathologies of the knee joint. However, it is important to understand that the preparation for such an operation must be serious.

First of all, you should take care of the implementation of the exercise therapy program even in the preoperative period. This will greatly facilitate the operation, and the rehabilitation period will be less long and painful. You should also pay attention to the drugs taken before the intervention. So, antidepressants should be canceled in advance before endoprosthetics (at least 2 weeks in advance).”

Vladimir

“Arthroplasty quite often becomes an option for many desperate patients. It is worth noting that with a responsible approach to this problem, amazing results can be achieved. To date, arthroplasty is the only effective way to treat advanced stages of arthrosis while maintaining knee function. The prosthesis, of course, cannot be compared with a healthy joint. However, with the complete destruction of the knee joint, it will restore the basic functions of the knee.

“If the knee arthroplasty is performed correctly and all the doctor's recommendations are followed in the postoperative period, the patient's recovery occurs quite quickly. Already on the first day after the intervention, such a patient is recommended to start performing specially designed physical exercises. You should also not neglect therapeutic massage and physiotherapy. Competent management of the patient in the postoperative period is the key to a successful result.

« In some cases, knee arthroplasty becomes the only possible way to improve the quality of life of patients with arthrotic changes in the structure of the joint. When a patient decides to perform knee arthroplasty, it is worth carefully choosing a clinic and a specialist. Particular attention should be paid to the choice of the prosthesis itself. A competent doctor will tell you which artificial joint is appropriate to choose, based on the age of the patient, his financial capabilities and anatomical features.

Anastasia

“Artificial knee prostheses can wear out over time. Re-endoprosthetics, as a rule, is not possible to perform. The only option to save the leg, after the wear of the prosthesis, is the complete immobilization of the leg in the knee area.

However, I would like to note that the current variety of artificial joints (more than 150 types) allows you to choose the best option based on the individual characteristics of the body. It is also worth noting that the main task of knee arthroplasty is to improve the quality of life of the patient. Even if the operation is successful, you should not forget that the operated joint should not be tested for endurance by excessive loads. If a person takes care of the operated joint, then it will serve him much longer.”

“Arthroplasty, of course, is a good method of treating degenerative joints, but it should be noted that such treatment is not yet sufficiently developed in our country. Hip arthroplasty in this regard is a more studied procedure. Domestic medicine is developing extremely slowly, but I sincerely hope that in the coming years our specialists will perform such procedures no worse than foreign ones.”

Alexandra

“At the advanced stages of development of degenerative-destructive diseases of the knee, arthroplasty is the most effective method for restoring joint function. However, even such a radical method of treatment cannot be applied in many patients. Knee arthroplasty is a serious and complex operation. The risks of complications far exceed the expected result in such pathologies as: advanced thrombophlebitis, a focus of infection in the patient's body, stage 3-4 obesity, lack of active extensor movements in the knee due to weak muscles (atrophy).”

Svetlana

Important fact:
Joint diseases and excess weight are always associated with each other. If you effectively reduce weight, then your health will improve. Moreover, this year it is much easier to reduce weight. After all, there was a tool that ...
Says a famous doctor >>>

• About expectations from surgery, prostheses and specialists
• First days after surgery
• How is home recovery going?
• We return to the normal rhythm of life

Total hip arthroplasty is a rather complicated operation in which the patient's diseased joint is replaced with an artificial analogue. Indications for such an operation are hip fracture, bone tumors, aseptic necrosis of articular tissues, as well as rheumatoid arthritis and coxarthrosis in the later stages, when conservative treatment does not bring the desired effect. A common feature of all these diseases is a significant or complete limitation in joint mobility and severe pain, which seriously reduces the quality of a person's daily life.

It should be noted that hip arthroplasty is a rather complicated and expensive operation, the cost of which largely depends on the location of the clinic and the level of specialists - for example, in Moscow the price of a package program in a good clinic is about 350 thousand rubles, and in Israel - about 1 million .

About expectations from surgery, prostheses and specialists

Such an operation on the hip joint as arthroplasty is a rather expensive “pleasure that often does not give quite the results that the patient expects. So, some people think that with the installation of a prosthesis, all problems will disappear almost instantly. In practice, everything is much more complicated - in most cases, of course, the pain recedes, the mobility returns to the joint and the patient's standard of living increases. But it should be noted that this does not happen instantly - first, a rather long period of rehabilitation follows, during which a person must develop a new motor stereotype, some movements that can lead to dislocation of the prosthesis, etc., must leave his “arsenal”.

In addition, there are cases when hip arthroplasty does not lead to the complete disappearance of symptoms, which may be due to various complications, the quality of the prosthesis, insufficient experience of the doctor, the age of the patient, etc. In this case, usually swelling and pain after surgery gradually decrease, but just don't disappear completely.

So, in about 2 percent of patients after hip arthroplasty, quite serious complications occur - an infection of the hip joint develops. But there is an even more common problem - the formation of blood clots in the veins of the pelvic region and legs. In such a situation, the rehabilitation period can be seriously delayed.

Therefore, each person wants to “play it safe” - choose the best prosthesis, find the most experienced doctor, etc. Then the patient comes to the chosen specialist with his wishes and demands that he be given just such a prosthesis, since, according to many, it is he who is the best. In fact, this is a serious mistake - any experienced doctor himself will select the model of endoprosthesis that suits you specifically, and he himself will offer alternatives. “The best” is a very relative concept, if such a one were invented, then there would be no others on the market. In addition, over a long period of work, each doctor has his own specific “preferences” - that is, those endoprostheses that have confirmed their effectiveness and sufficiently high quality in his practice. But when installing an unfamiliar design, even an experienced doctor can make mistakes. So it should be borne in mind that the main thing is the experience of the surgeon, and the quality of the prostheses is more or less the same.

What happens in the first days after the operation?

Rehabilitation after hip arthroplasty begins in the clinic. This stage is not too long - usually three to four days are enough for the patient's initial adaptation. If no violations are found, then the further rehabilitation process can continue at home.

On the first day after the operation, the patient needs to rest, and the joint cannot be loaded at this time. Therefore, a briefing is usually carried out immediately, in which they talk about the permissible loads on the prosthesis and about precautions. Also, the patient is taught several exercises that allow you to develop the joint. The patient's movements are still very limited, but he has the opportunity to sit down on the edge of the bed on his own and get up, leaning on the walkers. In addition, with the help of doctors, the patient can begin to move and even sit on a chair.

On the second day, the operated patient continues to learn exercises to develop muscles and joints, he can stand up and sit down on his own, and also try to climb stairs on crutches (all this is under medical supervision). You can also take a bath or shower.

On the third day, the patient is usually already able to independently perform physical exercises (which he was shown over the previous two days), sit and stand without support, and move around (depending on the condition - with or without crutches). After that, the patient can be discharged and sent to home treatment.

It should be noted that physiotherapy plays an important role these days. Its task is to teach the patient to "use" the resulting joint, with the help of special exercises to strengthen the muscles that are located around the prosthesis. All this together helps in the development of a new movement stereotype, because during the exercises the patient learns how to prevent joint displacement, what postures can be taken, what loads the joint can withstand, etc.

Rehabilitation at home

Rehabilitation after an operation such as hip arthroplasty is a rather lengthy process and requires care and responsibility from the patient. There are a number of points to which you should pay special attention:

• the skin in the area of ​​the operated joint should remain dry and clean, and the bandages should be changed in accordance with the recommendations of the doctor;
• you should follow the instructions of the surgeon regarding the care of the incision site, the rules for using the shower and bath;
• in some cases, it is necessary to undergo an additional x-ray examination so that the doctor can control the healing process;
• you should immediately consult a doctor if the body temperature rises to 38 degrees;
• it is also necessary to immediately go for a consultation with the attending physician if any discharge appears from the surgical wound, or redness is observed;
• if you experience such dangerous symptoms as shortness of breath and chest pain, you should also immediately consult a doctor;
• it may be recommended to apply ice to the joint several times a day if swelling persists for an extended period.

Drug treatment during home rehabilitation usually comes down to taking antibiotics, which prevent the development of infections in the joint, as well as anticoagulants, which prevent the formation of dangerous blood clots.

Also, one of the most important components of rehabilitation is proper nutrition. Usually the doctor does not impose special restrictions and does not suggest diets, but it is recommended to drink enough fluids, avoid high vitamin K intake and start taking some other vitamins, and supplement the diet with foods that contain iron. It is also necessary to limit the consumption of alcoholic beverages and coffee. It is also necessary to monitor the weight, since it should not be allowed to increase rapidly.

About returning to the normal rhythm of life

One of the main tasks of the patient is the development of a new motor stereotype, which allows avoiding joint dislocation. To do this, you must perform physical exercises and follow the recommendations of doctors on movement. So, for example, climbing or descending stairs on crutches involves maximum unloading of the prosthesis, so when lifting, the healthy leg is placed first, then the operated one, then the crutches, and when descending, the sequence is exactly the opposite - crutches - the operated leg - a healthy leg.

Within three months after the operation, you need to sit correctly. So, you can’t sit on low chairs, don’t cross your knees, don’t stay in one position for a long time and give preference to chairs and chairs with armrests, which allow you to partially redistribute the load. You should also follow your physiotherapist's instructions on how to sit and stand properly.

As a rule, after a month and a half, the patient can already safely use the stairs without crutches, after another two weeks you can drive a car and return to work.

With the high professionalism of doctors, knee arthroplasty significantly improves the patient's quality of life after surgery and almost completely restores the functionality of movements. It is carried out by replacing damaged structures with artificial ones. Indications for such an operation can be different - from injuries to serious inflammation caused by diseases of the musculoskeletal system. You will learn more about how knee prosthetics and rehabilitation after it takes place below.

What is knee arthroplasty

Violation of the functional abilities of the joint or its integrity, which is accompanied by constant pain or even the inability to bend the leg, is an indication for arthroplasty. This operation consists in the complete or partial replacement of the natural components of the knee with artificial materials. Instead of a joint, a prosthesis made of metal, plastic or ceramics is placed. The result of the operation is an almost complete restoration of leg function, improved mobility and elimination of pain.

Indications

Knee joint replacement as a general indication highlights the lack of a positive effect from complex drug treatment. If the patient continues to suffer pain up to the inability to bend the leg and even walk, then the only way out is surgery. Surgery to replace the knee joint may be prescribed in the following cases:

• deforming arthrosis;
• progressive rheumatoid arthritis;
• dysplasia;
• tumors and injuries;
• aseptic necrosis of the articular head or its fracture;
• the presence of osteoarthritis;
• infectious diseases affecting the knee joint;
• joint deformity with age;
• the presence of a dead area in the knee joint;
• significant changes in the articular shape.

Contraindications

Among the contraindications for knee replacement surgery, a number of absolute factors stand out. These include:

• infectious process in the knee joint less than 3 months before surgery;
• purulent infection;
• overweight, obesity 3-4 degrees;
• lack of a medullary canal in the femur;
• pathology of the vessels of the lower extremities;
• diseases of the hematopoietic organs;
• oncology 3-4 stages;
• kidney failure;
• decompensated stage of heart disease;
• skeletal underdevelopment;
• thrombophlebitis.

Types of knee joint endoprostheses

There are several different classifications of endoprostheses. According to the type of polyethylene liner, they are divided into mobile and fixed. Another classification is based on the number of surfaces to be replaced, which are determined based on the lesions of the knee joint. Endoprostheses can be:

1. Unicondylar. In this case, only one articular surface is replaced. This is due to the fact that the rest of the parts remained intact.
2. Bipolar. Here, the prosthesis replaces two surfaces of the knee joint.
3. Tripolar. This prosthesis already replaces three articular surfaces. It is most often used in total arthroplasty.

When replacing a knee joint, prostheses made of different materials can be used - titanium, a combination of metal with ceramics, or titanium-based plastic. There is another concept - an endoprosthesis of increased viscosity type LCCK. It is intended for those cases when it is impossible to stabilize the knee joint with a traditional tissue release or in case of incompetent collateral ligaments.

The latest development is a liquid prosthesis. It is also called an implant. It is a mixture of sodium hyaluronate and hyaluronic acid. The latter acts as the basis for the prosthesis of the synovial fluid of the knee joint. It looks like liquid. Only here hyaluronic acid is used to replace the synovial fluid, which reduces friction between the cartilage in the knee joint and slows down the destructive processes. According to the type of connection, endoprostheses can be:

• unrelated;
• related;
• articulated;
• semi-connected.

Training

Upon admission to the hospital, the patient is examined, asked clarifying questions, and then informed about the upcoming operation. In the preparatory period, he is prescribed some procedures:

• blood and urine tests;
• chest x-ray;
• spirogram;
• other studies according to the testimony of narrow specialists.

In the preparatory period, the anesthesiologist and surgeon assesses the patient's condition as a whole, the risk of complications. With this in mind, choose the type of prosthesis. Previously, the patient may be asked to donate blood to make up for its loss after the operation. As preparation, doctors are beginning to recommend pre-workouts with crutches. So rehabilitation after arthroplasty will be much easier.

How to change the knee joint

The knee replacement technique requires a high degree of professionalism and concentration from the surgeon. The whole operation lasts about 2-4 hours, depending on the number of surfaces to be replaced. Most often it is appointed in the morning. Before anesthesia, the patient's healthy leg is bandaged to prevent the formation of blood clots. Next is anesthesia. It can be general anesthesia and spinal anesthesia.

Additionally, a catheter is inserted into the bladder to control secretions from the kidneys. With the onset of the anesthetic effect, the doctor begins the operation. The knee replacement technique is as follows:

• a longitudinal incision is made in the central part of the knee;
• tissues move apart from the incision;
• the patella moves to gain access to the joint;
• the tension of the ligaments and soft tissues is weakened;
• damaged bone elements are removed, cut edges are processed;
• the prosthesis is replaced first by the lower part of the femur;
• in the upper part of the tibia, a flat titanium plate and a polyethylene liner are fixed on it;
• further, the functioning of the joint is checked by installing a trial prosthesis;
• after successful testing, a real endoprosthesis is fixed;
• dissected tissues are sutured, drainage is established;
• a bandage and a splint are applied, after which the patient is transported to the ward.

Rehabilitation after knee arthroplasty

On the first day after the operation, it is still impossible to get out of bed, but leg movements are not limited. With good health, the patient can sit, hang his legs out of bed, but the level of the knee joint should be lower than the hip. Later, you are allowed to stand up with crutches. The rehabilitation program is compiled by the doctor, taking into account the individual physiological characteristics of the patient. In general, it includes several different activities - physiotherapy exercises, proper nutrition and a number of necessary procedures, such as lymphatic drainage, cryotherapy, etc.

exercise therapy

Therapeutic exercise, along with special massage and physiotherapy, is a condition for the success of a long rehabilitation after endoprosthetics. This stage lasts about four months. At this time, the patient learns to walk on the stairs, correctly distribute the load and increases muscle strength. All this is necessary for a strong fixation of the joint. Light motor activity with a small range of motion helps to restore muscle tone and improve movement. You can easily perform special exercises at home, for example:

• extensor and flexion movements of the ankle joint;
• alternating contraction of the muscles of the thigh and lower leg;
• tension and holding a slightly raised straight leg in a prone position;
• alternately raising straightened legs;
• flexion and extension of the knee joints, but at an angle of not more than 90 degrees;
• abduction of the leg to the side or back in a standing position.

Massage

The complex of rehabilitation measures is not limited to physical education. Another important component of recovery is massage, but it must be done with great care. It's not worth doing it on your own. Postoperative massage without risk and according to the rules can only be performed by a specialist. The procedures will help reduce swelling after arthroplasty, relax the muscles and prevent the formation of blood clots. In addition, thanks to the massage, pain is reduced, improves the general condition and accelerates the healing of tissues.

Complications

Unlike hip arthroplasty, complications are more common with knee replacement, which is why reviews about the operation are so contradictory. Compliance with all doctor's recommendations regarding the rehabilitation period helps to reduce their likelihood. Complications may affect the endoprosthesis itself or the general health of the patient.

Should not be afraid of swelling after surgery. It stays on for about 10 days. If the swelling does not go away after a long period of time, about 2 weeks, then there is a risk of developing infectious processes in the prosthesis or an allergy to its components. Then you need to consult a doctor. Other possible complications include:

• displacement of the prosthesis;
• thrombus formation in the lower leg;
• fracture of the femur;
• deep vein thrombosis of the lower extremities;
• damage to the vascular bundle;
• divergence of the wound;
• formation of bone outgrowths, excessive scarring around the endoprosthesis;
• rejection of the prosthesis;
• dislocations.

Complications during the operation are due to physiological characteristics and the state of health in general. Here, heart or respiratory failure, circulatory disorders in the brain, damage to nerves and blood vessels, a fracture or fracture of the bone can occur. After surgery, everything depends on the disease or injury, lifestyle and adherence to the recommendations of the doctor. Ignoring strengthening exercises negatively affects recovery.

Price

Another important question regarding this operation is how much does a knee replacement cost. The cost of arthroplasty consists of several components:

• the location of the operation;
• the cost of a knee prosthesis;
• the complexity of the operation.

Turning to the local public clinic, you will most likely have to face a queue for several months in advance. This is especially true in cases where the state offers to buy a prosthesis or pay for arthroplasty. Replacement of the knee joint in this case can be free, but treatment according to the quota is necessarily accompanied by queues. And to get it, you have to go through many instances.

In this case, it is more rational to go to a private clinic. Although the cost of a knee replacement surgery there will be high, you don’t have to wait in line. Approximate prices for Moscow are shown in the table:

You can find an expert opinion on knee arthroplasty, as well as patient reviews on the website.

Each element of bone tissue in the body performs a complex function. Loss or destruction of the knee joint leads to a violation of the motor activity of a person or completely deprives him of the ability to move. Various types of treatment are practiced to restore cartilage or replace joints.

You will learn

Operation types

There are many options for the operation, as a rule, it all depends on the case:

• Ligament tear repair

Violation of the integrity of the connective tissue is restored by stitching with a special material. Tears and loss of contact with the joint occurs with dislocations, fractures and combined injuries.

• Arthroscopy

It is carried out using an endoscope for diagnosis and treatment. The operation is monitored through a camera. Such equipment is an excellent alternative to cavitary access.

• Debris reposition

It is required to match the damaged elements of the knee joint (more often on the surface). During the procedure, osteosynthesis is performed, when the fragments are connected with special fasteners. They eliminate the consequences of a fracture.

• Arthroplasty

Restorative and corrective treatment associated with the plastic surface of the knee joints. Often used for complete ossification and immobilization of cartilage.

• Repair of the meniscus

The cartilage pad, which plays the role of a knee shock absorber, is operated on in the early stages of injuries. It is shown to people at a young age. There are several ways to reconnect the meniscus to the joint.

Prosthetics

One of the most difficult areas in the treatment of the knee joint. An individual implant made of polymeric materials is selected for each patient.

During the operation, a complete or partial replacement of the joint is performed with the full restoration of knee functionality with a synthetic prosthesis.

The introduction of the implant is carried out with the complete destruction of the knee joint, when the question arises of the ineffectiveness of conservative or other methods of treatment.

Indications:

• degenerative processes of cartilage and joints;
• destruction against the background of infections;
• tumors and cysts;
• deformation in autoimmune pathologies ( , ).

Contraindications:

• insufficiency of the respiratory system, lung pathology;
• circulatory disorders with deep vein thrombosis;
• infectious lesion of the joint with an outpouring of purulent contents;
• some chronic infections;
• deviations in blood clotting;
• diabetes;
• extreme obesity;
• cancer disease;
• serious deviations in mental health;
• heart failure;
• irreversible atrophy of the muscles surrounding the joint;
• osteoporosis and unstable cartilage.

Types of endoprostheses

There are three technologies for replacing the affected osteochondral element in the knee:

• Insertion of a unilateral implant or Trace prosthesis (partial bone replacement on a sliding surface is characterized by minimal bone removal)
• Total joint replacement(with abrasion of cartilage on the entire surface of the joint, when the ligaments are not touched).
• Total joint replacement with axis correction(the implant is adjusted taking into account the condition of the bone and adjacent elements, an extended replacement is practiced).

Endoprosthesis replacement of the knee joint is carried out on a strong bone cement, which undergoes rapid hardening. The material provides a guarantee of fixation of the implant with the possibility of loading after rehabilitation.

Preparing for the operation

In order for the operation to be successful, you must:

1. Before surgical treatment, it is necessary to undergo a diagnosis to assess the general state of health. Laboratory and instrumental studies will help identify possible pathologies in which knee arthroplasty is strictly prohibited.
2. Standard studies include general and biochemical blood sampling, urinalysis. Before the operation, the patient must be tested for HIV and the Wasserman reaction (syphilis). Be sure to check the level of blood clotting and the group.
3. Fluorography will refute or reveal pulmonary pathologies in which surgery is contraindicated. Additionally, in-depth studies (computed tomography or MRI) can be carried out.
4. The joint replacement procedure is planned, so it is carried out in the morning. The last meal should take place no later than 19.00-21.00 before the day of surgery. Drinking before anesthesia is not recommended, it can provoke vomiting during the administration of anesthesia or anesthesia.

Each patient may have individual preparation, the details of which are described by the treating specialist. The use of systemic drugs, the cancellation of which is impossible, must be reported in advance. If there are allergic reactions to medications, this should be noted in the medical history. You may need additional consultation with an allergist.

Operation progress

Several types of anesthesia can be used for knee surgery. The final decision on the type of anesthesia is made by the doctor. This may be anesthesia through an endotracheal tube, intravenous administration or spinal anesthesia.

Usually, joint prosthetics is performed under deep anesthesia with the use of muscle relaxants. This will increase access to the area during the operation and remove muscle resistance:

1. The patient is given anesthesia on the operating table. When it finally takes effect, an inflatable compression cuff is placed on the thigh. Blocking the flow of blood is necessary for further cementation of the prosthesis.
2. The knee joint is opened and the destroyed cartilage completely or part of it is removed. With superficial prosthetics, the lateral ligaments are preserved. The remaining undeformed bones are given a shape that will exactly match the surface of the prosthesis. During the junction, the knee and leg are immediately corrected in the axis.
3. Before the real prosthesis, a trial fitting is carried out. The surgeon checks the surfaces adjacent to the joint, the strength of the ligaments and the maximum mobility of the implant.
4. After that, the doctor installs the original prosthesis on the cleaned and washed bone tissue using cement. The material immediately hardens and creates a strong bond with the bone tissue.
5. If bone defects are pronounced, the fastening is strengthened by lengthening the holding parts of the implant. The patella is kept in a normal state during prosthetics.
6. Upon completion of the surgical actions, the motor ability of the prosthesis, the condition of the ligaments are checked and the axes are corrected. A tourniquet is no longer required, but if bleeding has opened, it is immediately eliminated. Ordinary knee drainage will help to exclude the appearance of a hematoma.
7. The joint bag and skin are sutured, a pressure bandage is necessarily used.

A standard operation without deviations and complications lasts about 90 minutes. The last step will be to check the installation of the prosthesis through radiography.

With the technique of the operation, video reviews of patients after treatment, as well as advice on postoperative recovery, you can find on this site.

Rehabilitation after knee surgery

The recovery process after implantation has several methods. These include therapeutic exercises, physiotherapy and drug therapy. Rehabilitation begins immediately after surgery in a hospital setting. The specialist necessarily advises the patient and gives the necessary exercises, describes the procedures that will need to be performed at home.

All methods for restoring the functionality of the knee are individually developed. The severity of the pathology, weight, physical fitness and possible chronic diseases are taken into account. Following the recommendations of doctors, the recovery of motor reactions reaches from 80 to 90%. The duration of rehabilitation lasts at least 4 months with regular exercises.

Rehabilitation at home

After the operation, not many patients have the opportunity to stay in the clinic until complete rehabilitation, especially if the treatment was carried out abroad. Elderly people will also feel more comfortable during the restoration of the house. In the room, you can install auxiliary simulators and, as you get tired, stop the procedures:

1. It is necessary to develop the knee moderately, adhere to the average pace and not exceed the load. The main role in rehabilitation is played by regularity and conducting classes at a certain time. Regular exercise requires patience. Results are not possible after a few exercises.
2. Along with therapeutic exercises, the patient is recommended to go for massage and swimming. With discomfort in the knee and other symptoms, drug therapy is temporarily prescribed.
3. The first three days master the elementary movements of the limb. Sitting, transferring to a chair, and getting up on your own may be difficult. Gradually increase the load, carry out trips indoors. In a deeper rehabilitation period, they climb stairs and walk for a short time.
4. All movements are desirable to be carried out under the control of relatives. They also use a safety net for the joint in the first weeks with the help of crutches and a cane.

Possible complications after surgery

The patient is informed about the troubles after arthroplasty even during the diagnosis. Complications of the joint are of a single nature, since the treatment is carried out only by qualified specialists. According to the results of controlled studies, the most common complications are:

• dislocation of the prosthesis (1.8%);
• septic shock from infection (1.37%);
• thromboembolism or acute vascular occlusion (0.3);
• periprosthetic fractures (0.2%).

In most cases, complications in the prosthetic joint occur due to the fault of the patients. They do not adhere to the doctor's prescriptions, do not continue high-quality rehabilitation. Usually the deterioration occurs at home. If endoprosthesis replacement was performed, and the restoration of the limb did not occur, this is the result of the lack of systematic exercises.

Cost of knee replacement surgery

Modern medical centers for joint restoration exist in many countries. Some of them are distinguished by special qualifications, high-tech equipment and excellent experience of specialists. The high success of implantation is noted in foreign clinics:

1. The highest rate of joint operations remains in Germany. Every year, more than 155,000 endoprostheses are performed there for patients from around the world. Medical Center Nordwest Clinic, Frankfurt am Main. Price: from 10,000 euros.
2. Israeli specialists annually perform more than 7,000 successful joint surgeries per year. The country has the best rehabilitation centers and good equipment. Hadassah Clinic, Jerusalem. Price: from 17,000 dollars.
3. Joint replacement surgeries are carried out in domestic clinics. Every year in the Russian Federation, more than 2,000 patients from different regions are treated according to the quota. The centers in St. Petersburg, Moscow and Kazan are the most popular. Moscow City Center for Endoprosthetics of Bones and Joints. Price: from 400,000 rubles.
4. One of the leading clinics in Turkey is famous for its robotic system for complex joint implantation tasks. The MakoPlasty system accurately inserts the endoprosthesis. Clinic LIV Hospital. Price: from 18,000 dollars.
5. Clinics in Lithuania are much cheaper than other European centers, but the patient is offered quality service and excellent joint treatment. Lithuanian specialists are trained in the USA, Germany and other developed countries. Price: from 9000 dollars.

Implantation of the knee joint is the right solution to preserve the full function of the knee. After some time, the patient will be able to restore their usual way of life, return to work. The operation of endoprostheses is maintained for a long time, but periodically it will be necessary to undergo an examination by an orthopedist.

The knee joints are larger than all other joints in the human skeleton. This is not surprising, because they have a colossal burden. Thanks to them, a person can maintain a vertical position of the body, walk on two legs, and perform various complex movements. But heavy, and sometimes excessive loads do not go unnoticed for the knee joints: they are injured or inflamed.

Some types of injuries and diseases cannot be cured by therapeutic methods. In such cases, the only way to return patients to the ability to walk normally is through surgery. This is a knee replacement surgery.

Indications for knee replacement

All patients are afraid of operations, so they try to avoid them by any means. They are ready to endure severe pain, limit their life opportunities, try to be cured by conservative methods. However, in most cases, such forbearance is only contributes to the further progress of the disease, and surgical intervention becomes inevitable.

Most often, the operation to replace the patella is performed due to serious degenerative changes in the joints that have developed as a result of arthrosis. This disease does not occur on its own. As a rule, it is preceded by the following pathologies:

Despite all the variety of prerequisites for the development of arthrosis, doctors still consider excessive mechanical stress on the knees to be the main one, which provokes frequent microtraumas and uneven wear of the articular surfaces.

The patient cannot help but notice the development of arthrosis knee joint, because this disease is accompanied by the appearance of the following striking symptoms:

• A person feels severe pain during a simple walk. Painful sensations can also occur in the morning and during the day at rest.
• The patient's gait is disturbed. Moreover, these violations are first noticed by the patient himself, and then by strangers. Later, the diseased joint begins to swell. In the surrounding tissues from time to time there is a feeling of numbness.

It should be said right away that degenerative changes in the joint that develop against the background of arthrosis are irreversible. . Therefore, when forming a pronounced form pathology, you should not torture yourself and postpone the operation. The effect of anti-inflammatory therapy will be temporary.

Preparation for surgery

So the patient decided to have surgery. It's time to properly prepare for it.

Preparation for knee replacement surgery is not limited to instrumental research methods and analyses. The patient must change his lifestyle and give up bad habits.

Preparation for a joint replacement procedure usually begins a few weeks before surgery. The patient must undergo the following examinations:

• X-ray examination of the chest organs.
• General analysis of urine and blood.
• Biochemistry of blood.
• Coagulogram.
• Electrocardiogram. It is essential for older patients.

If necessary, consultations with other specialists can be held if there are pathologies of other organs and systems.

These types of examinations are needed primarily by anesthesiologists, because they have to choose the right anesthesia. Depending on the general condition the patient's body, doctors can give him general anesthesia or epidural anesthesia. In the latter case, the patient will be conscious throughout the operation.

If the patient has any concomitant pathology that can interfere with the surgical intervention or adversely affect the predicted result, then the attending physician does everything necessary to stabilize its course.

In the postoperative period, the patient will not be able to fully use the operated leg for a long time. Therefore, it is necessary that he tone the muscles of the shoulder girdle. In the future, such training will facilitate the use of such medical equipment as walkers and crutches.

Particular attention is paid to medications used before surgery. Any anticoagulants and drugs with acetylsalicylic acid are banned. The latter is known to increase bleeding.

The patient will have to give up bad habits such as smoking and drinking alcohol. They can negatively affect the speed of postoperative recovery.

Immediately before the replacement of the knee joint, a catheter is inserted into the patient's bladder so that the doctor can control the amount of urine excreted during the operation.

Operation progress

During the operation, surgeons replace the damaged knee joint of the patient with an endoprosthesis. The latter in size and shape must completely copy a healthy joint, so the endoprosthesis is made individually for each person.

The endoprosthesis replaces part of the femur and tibia and is attached to them with bone cement. The knee's own intact ligaments are used to stabilize the artificial joint. At the same time, the functional endoprosthesis is as close as possible to the physiological parameters of a real knee joint.

At the beginning of the operation, surgeons open the knee and take the patella aside. This allows them to assess the condition of the affected area and proceed to the removal of all osteophytes and pathological growths of bone tissue. All work is carried out with pinpoint accuracy., because only this approach will allow in the future to correctly install and fix the prosthesis.

After preparing the bones and removing the joint, it is replaced with an endoprosthesis. The latter is attached to the bones with bone cement. To ensure an acceptable level of mobility of the artificial joint, the removed cartilage is replaced with polyethylene liners. The operation is completed by installing drains and suturing the wound.

How long does knee replacement surgery take? It all depends on the type of operation. For example, if the knee is partially affected, doctors may perform a unipolar replacement. This operation takes less time.

On average, surgeons completely replace a knee joint in 1 hour and 30 minutes.

After the operation, the patient is treated with antibiotics to prevent possible complications. . In the first 2 days he receives strong painkillers.

The drains installed during the operation are removed after a couple of days, when the doctors make sure that there is no bleeding and exudate. The stitches are removed after two weeks. Usually by this time the patient begins to walk with crutches and undergo a rehabilitation course.

Complications after knee replacement

The operation to replace the knee joint with an endoprosthesis is very complicated. Therefore, despite all the achievements of modern medicine, there are risks of developing various complications. Most often they develop in older people with various concomitant diseases.

After surgery, the following complications may develop:

In order to minimize these complications, doctors immediately after the operation carry out various preventive measures.

Rehabilitation

Immediately after the operation, the patient can not walk for several days. However, this does not mean at all that he should lie motionless. Already in the first days after the change of the knee joint, the patient should begin to work on restoring mobility in the knee. This is the start of rehabilitation.

Rehabilitation activities I focus on strengthening the muscles of the knee, developing ligaments and ensuring maximum joint mobility. They are carried out both in the hospital and in rehabilitation centers. Independent rehabilitation is unacceptable, as this can lead not only to complications, but also to injuries.

Any exercises to restore knee mobility immediately after surgery should be performed lying down, and later sitting. Moreover, the exercises must be performed immediately with both legs. This will avoid thrombosis of the lower extremities and activate the muscles. All exercises should be performed under medical supervision. The fact is that some universal measures may not be effective and dangerous for a particular patient.

After the permission of the attending physician, the patient proceeds to perform rehabilitation exercises while standing. Later, he will be able to walk with crutches and exercise on an exercise bike.