Hip endoprosthetics

Degenerative disease is the most common irreversible joint disease in the case of which articular cartilage is destroyed. In the beginning, the patient feels pain during movement, followed by pains without movement and by night pain. As the disease progresses, there is crackling during movement, limitation of mobility in the joint, sometimes distortion of the limb axis, and at last severe mobility problems.

The rate of disease development varies for each patient. The course of the disease depends on many factors. Common causes of degenerative disease are: obesity, metabolic disorders, systemic diseases, osteochondral necrosis, untreated congenital dislocation of the hip, dysplasia, intraarticular structures damage, inflammatory or post-traumatic changes. In the primary stages of degenerative disease, the doctor may recommend rehabilitation and use of analgesics. Advanced degenerative changes with chronic pain syndrome can be treated only by a procedure of implanting an artificial joint.

A surgical procedure is based on replacing the damaged joint with an artificial one made of wear-resistant materials. Elements which form an artificial joint are the mandrel pin, the endoprosthesis stem, acetabulum and insert. Depending on the patient’s age and medical indications, the endoprosthesis is placed on the bone without glue – un-cemented endoprosthesis or with the help of bone cement – cemented endoprosthesis.
In the case of un-cemented endoprosthesis, a permanent connection is made through bone ingrowth into the porous material which covers the endoprosthesis. During the procedure, the prosthesis is impaled into the so-called tight connection. On the other hand, in the case of cemented endoprosthesis, a permanent connection of bone prosthesis is made with the use of bone cement (a type of glue), which connects the shank and the acetabulum.

The surgeon decides on the type of endoprosthesis, and his decision is influenced by: the patient’s age, accompanying diseases which affect the bone quality, obesity, past physical and professional activity. It is important that a change of plans for the type of implanted endoprosthesis can be made during the surgery itself. Much simplified, it can be said that the treatment of cementless endoprosthetics is performed in people with good bone quality.

Endoprosthetics is usually performed under subarachnoid anesthesia. There is no feeling of pain from the waist down. The skin is cut on the side.

The procedure can be performed from two different accesses. Upon reaching the joint, the damaged femoral head is cut off, next the prosthesis is impaled or glued into the endoprosthesis, on which the endoprosthesis head is applied. At the next stage of the procedure, the surgeon removes the damaged surface of the acetabulum of the ilium so that he can place an artificial acetabulum. In the final stage of the procedure, it is verified whether all elements fit together and whether the endoprosthesis does not tend to dislocate. During the first 48 hours after the surgery, a drain is left in the joint. We routinely perform laboratory tests and a test X-ray image in days zero, one and two.

The rehabilitation of the patient begins the day after surgery. Rehabilitation consists of individual exercises with the rehabilitant and his aid in the first upright standing, he teaches movement with the help of elbow crutches training as well as gives instructions on unassisted exercises. On the last day the patient learns to move up the stairs. Additional support in the rehabilitation process is the use of CPM braces for continuous passive movement.