Normally the joint surfaces are covered with a slippery and smooth cartilage texture. In this way, the movements are smooth and painless. The surface cartilage of the joint exceeding, increases friction during movements and joint movements are being limited and painful. This is called calcification (arthrosis). Replacing damaged surfaces of the joint with arthrosis is called prosthesis surgery.
Prosthetic surgery is necessary if there is a pain in a level which will effect your daily life, limitation of movement, leg posture deformity, leg shortness or non-stopping pains during resting.
It is recommended to perform prosthesis operations after 65 years of age due to calcification. The reason for this is to reduce the number of future prosthesis replacement operations.
However, age is not a definite criterion for determining the operative time, but if the patient’s quality of life is reduced and the pain is in uncomfortable level (unresponsive to analgesic treatments and restricts your life), is the actual criteria. Prosthetic surgery can be performed at any age when this condition occurs.
Prosthesis consists of metal (cobalt chrome, metal ceramic (zirconium), titanium), plastic (polyethylene) or ceramic surfaces.
Although the material to be used varies according to the person and the process, the materials used generally do not cause allergic reactions in the body and are resistant to breakage and spoil. In our society, the majority of patients called “prosthesis did not adapt to the body” are patients with prosthesis infection.
Hip prostheses can be divided into different types according to the method of fixing to the bone or the materials used on the jointing surfaces. The type of prosthesis to be used is generally determined by the patient’s age, bone quality, lifestyle and past experience of the surgeon.
During the pre-operative examination, by talking the anaesthesiologist the method to apply is decided. Even though the decision is made according to the patient, we prefer general anaesthesia because it provides better muscle relaxation in hip replacement surgery.
It takes 1.5-2 hours on average. The patient leaves from the operating room 3-4 hours in total, one hour is preparing to surgery and half hour is after recovery.
Most commonly in nowadays; hip replacement is performed through three different incisions or in other words, through access. Access roads have their own advantages and disadvantages. Selection should be made by the surgeon according to the patient.
With the use of appropriate surgical techniques and modern prosthesis designs, the survival of hip prostheses has been extended to 15-20 years. It can prolong this period if patients keep their low weight muscles strong and avoid excessive compelling activities. At the end of this period, the loosen prosthesis or loosen parts of the prosthesis are replaced. by surgery. This change is called revision surgery.
For many years, prosthesis surgeries have been successfully performed in specialists’ hands. However, despite all the precautions taken, some of the following undesirable complications can be seen:
New prosthesis designs and modern techniques allow patients to walk with a hand support one day after surgery.
The average length of hospital stay is 2-4 days.
You can drive 6 weeks after the operation with the condition that the driver’s seat is high and not leaning forward.
Walking can be started 6 weeks after surgery. Sports might be done that do not require sudden movement such as swimming, exercise bikes which also doesn’t have falling risk too much.
– 5 days from the sand
– plavix 7 days
– trental 7 days
– aspirin 10 days
– all vitamins and supplements 10 days
– painkillers (NSAIDs) 10 days
– methotrexate 2 weeks
– diet medications should be stopped before 2 weeks .
Learning and performing preoperative exercises will provide early recovery. Exercises are started a few weeks before the operation, the exercises are started 2-3 times a day and with 5 repetitions, the number is increased over time. Always warm up by walking or cycling before exercising.
– Swelling, empurpling: In the surgery area, there might be a swelling in different levels depending on person. While this swelling decrease, empurpling starts to be seen. Over time, this empurpling is fade away by turning into yellow.
– Swelling of the leg: In first month, sitting while hanging legs through ground increases swelling of the leg. If leg is supported with a pillow from below and therefore keeping as elevated will decrease swelling. Ice, cold shower applying, bandaging or anti-embolic socks wearing will decrease swelling. Again, for not to have swelling, exercise performing is suggested. In the case of not decreasing or increasing of swelling, consult to your doctor.
– Length difference: Specially after hip prothesis, length difference may be expected in the early period, Strained hip muscles tilt to the pelvis to one side is the cause of that. Balancing of pelvis would take 6-8 weeks.
-Wound Care: Keep surgery area clean and dry, don’t make it wet. If you are using watertight medical dressing, you may take shower after day 3. If there is redness or heat increase or leaking on wound area, certainly inform your doctor! …
– Call your doctor in following cases;
Over 38-degree heat, increasing pain in surgery area over time, swelling, rubesence, heat increase case, laboured breathing, chest pain or wheezing.
While, starting to exercise in early period after surgery and performing exercise systematically; provides movement also increase muscle strength of patients and provide more faster returning to their life.
Start every exercise 3-4 times in a day and with 5 repetitions then numbers are increased over days. If there is pain, swelling, heat increase or sensitivity lower numbers. If complaints still continue, consult to your doctor.
You may watch exercise programs after hip prothesis from following videos.
Following hip replacement, the following movements should be considered for 6-12 weeks in order to heal the prosthetic hip capsule or to prevent dislocation.
While sitting, go back until the back of your knees touches the seat / bed. Leave the walker to get support from the sides of the seat or bed with your arms and sit with your surgical leg sliding forward. Do not lean forward while sitting.
Do the opposite of this when you stand up. Extend your surgical leg to the front while pushing yourself up from the seat / bed with your arms. Never lean forward. When fully flat, remove the walker / cane.
Do not make sudden turns with the walker. Take short steps and turn with your firm leg. Do not get support from the walker while standing and sitting.
An important point to remember is that you cannot use the alaturka toilet!
Sitting on the toilet: Sit back to the toilet until you feel your legs touch. Hold the toilet support while leaning back with your surgical leg in front. Leave the walker. With support from both arms, slowly move yourself closer to the toilet and sit down.
Getting Up From the Toilet: Slide your operated leg forward and hold the toilet support. Use both arms to stand up and then hold your walker.
NEVER get support from your walker while sitting on the toilet!
Use ancillary equipment (dressing stick, holder) when wearing underwear, pants or socks. NEVER lean forward.
Sit on the edge of the bed and get yourself back on the bed using both hands. you can ask for help to keep your legs apart. When you get out of bed, do these movements in reverse.
On a flat surface, you can initially bath in a shower in the form of a plastic chair or standing.
In general, sexual intercourse can be performed 4-6 weeks after surgery. Initially, positions where the patient is passive should be preferred. A more active role can then be started.
Recommended sports: Swimming, aerobic movements, cycling, golf, dancing, etc. Not recommended sports: sports that require running, jogging and sudden movement (football, basketball, etc.), contact sports, heavy work.
It is very important that other doctors and dentists who treat you know that you have joint prostheses. In all dental interventions; including tooth extraction, root canal treatment, dental calculus cleaning; In all interventions to the gastrointestinal tract or urinary tract; including endoscopy, colonoscopy, urinary tract closed technique; Upper respiratory tract diseases and interventions; In all serious infections, antibiotic protection is needed to prevent the prosthesis from becoming infected by blood. For this, 2 g cephalectin, amoxycillin or cefazolin by injection or 600 mg clindamycin should be taken orally 1 hour before the intervention.