Complications after hip arthroplasty. Why does my knee hurt after hip arthroplasty?

New medical discoveries made possible recovery activity of the lower extremities due to prosthetics pelvis hip joint. This procedure helps to get rid of debilitating pain and discomfort, restores the functioning of the legs and helps to avoid disability. But sometimes there are various complications after hip arthroplasty. Pathologies can develop due to a medical error, infection, non-engraftment of the prosthesis, improper restoration procedures.

Common complications after hip arthroplasty

The operation to replace the hip joint of patients with an artificial one has been carried out for more than thirty years with great success. Such an intervention is especially in demand after hip (neck) fractures, injuries musculoskeletal system when the cup wears out due to age-related changes. Regardless of the cost of hip replacement surgery, complications are rare. But with untimely treatment of problems, the patient is threatened with disability, immobility of the lower extremities, and with pulmonary embolism(thromboembolism) - death.

Conventionally, all the causes of the consequences and difficulties of the postoperative period after such prosthetics are divided into several groups:

• caused by non-perception of the implant by the body;
• backlash on a foreign body;
• allergy to the material of the prosthesis or anesthesia;
• infection during surgery.

Complications after hip prosthetics negatively affect not only the thigh area, but also affect the general physical, psychological state, physical activity and walking ability. In order to regain your previous health, you need to go through a series of rehabilitation measures, which are appointed based on the developed pathologies and problems. For fast and effective recovery it is necessary to establish the causes of complications and limitations after hip arthroplasty.

General complications

The development of the medical industry does not stand still, every year there are hundreds of discoveries that can change lives, give a chance to many patients. But complications after surgical intervention occur frequently. During hip arthroplasty, in addition to specific difficulties, general pathologies may occur:

• Allergy to medications that were used before or during surgery. For example, anesthesia.
• Deterioration of the work of the heart muscle (an operation is always a burden on the heart), which can provoke seizures and diseases of cardio-vascular system.
• Violation of motor activity, which is provoked not by the perception of the body foreign body or an allergy to the implant material (e.g. ceramic).

Infection in the area of ​​operation

Often, during a hip arthroplasty operation, such a complication occurs as infection of the soft tissues at the site of the incision or the implant itself. What is the danger of an infectious lesion:

• Arise severe pain in the field of surgical intervention and placement of the endoprosthesis.
• At the site of the incision, suppuration, swelling and discoloration of the skin are observed.
• Septic instability of the new joint can become critical, which leads to a violation of the motor function of the lower extremities.
• Fistula formation with purulent secretions which is especially often observed if timely treatment is not started.

So that complications after hip arthroplasty do not nullify the efforts during the operation, it is necessary to select and start treatment in a timely manner. Taking special antibiotics and using temporary spacers (implants) will help get rid of the infection. The treatment process will be long and very difficult, but the result will please the patient.

Pulmonary embolism

The most dangerous complication that can develop after the installation of an artificial joint (endoprosthesis) is thromboembolism. pulmonary artery. The formation of blood clots is often provoked by the immobility of the leg, which leads to impaired blood circulation in the lower extremities. This disease often ends in death, so you need to carry out preventive measures, for example, take anticoagulants, which are prescribed by a doctor for several postoperative weeks.

blood loss

Bleeding may occur during hip replacement surgery or shortly thereafter. The reasons are a medical error, careless movement or abuse of medications that thin the blood. In the postoperative period, anticoagulants are prescribed to prevent thrombosis, but sometimes such caution can play a cruel joke, turning preventive measures into a source of trouble. The patient may need a blood transfusion to replenish supplies.

Dislocation of the head of the prosthesis

One of the complications after hip arthroplasty is dislocation of the prosthesis head. This complexity is caused by the fact that the endoprosthesis is unable to completely replace the natural joint and its functionality much lower. Falls, improperly performed rehabilitation, performing complex exercises or sudden movements can provoke a dislocation, which will lead to complications. As a result, the work of the musculoskeletal system will be disrupted, activity lower limb.

To avoid complications after arthroplasty, one should be extremely careful in movements in the postoperative period: do not turn the leg too much inward, its flexion in the hip joint should not be more than 90 degrees. Revision hip arthroplasty will help to eliminate the complication, and for complete healing, it will be necessary to completely immobilize the leg for some time.

Loosening of the endoprosthesis design

As a result of vigorous activity, movements of the legs, loosening of artificial joints occurs. This negatively affects the bone tissue. Loosening causes destruction of the bone where the endoprosthesis is inserted. Subsequently, such instability of the prosthetic site can lead to a fracture. The only option to prevent loosening is to reduce motor activity, and to eliminate the problem that has already appeared, revision arthroplasty of the hip joint is used.

Lameness

Lameness is a common complication after hip arthroplasty. Such a pathology can develop as a result of some cases:

• Patients who have had a broken leg or femoral neck often experience shortening of one leg after hip replacement surgery, resulting in lameness when walking.
• Long-term immobilization, the state of rest of the lower limb can provoke atrophy of the leg muscles, which will cause lameness.

Helps get rid of complications surgical intervention, during which there is an increase in bone tissue to equalize the length of the legs. Patients and physicians resort to this option extremely rarely. As a rule, the problem is solved by using special insoles, linings in shoes or wearing special shoes with different heights of soles and heels, which are sewn to order.

Groin pain

A rare complication after hip arthroplasty is pain in inguinal region from the surgical intervention. summoned pain can be a negative reaction of the body to the prosthesis, an allergy to the material. Pain often occurs when the implant is positioned anterior section acetabulum. Get rid of pain syndrome and get used to the new joint will help the implementation of special exercise. If this does not bring the desired result, revision arthroplasty will have to be performed.

Swelling of the legs

After surgery, as a result long preservation legs at rest, often there is a complication such as swelling of the lower extremities. The blood flow, metabolic processes are disturbed, which leads to swelling and pain. Taking diuretics, keeping your legs elevated, using compresses that relieve swelling, as well as regular simple exercises will help get rid of such a problem.

Therapeutic exercises for recovery after arthroplasty

To get rid of complications after hip arthroplasty, and to make the rehabilitation process as quick and painless as possible, it is necessary to regularly perform physical exercises prescribed by the doctor. Thanks to simple actions, the motor activity of the new artificial joint develops, the patient returns to the ability to move with his legs without the use of crutches.

A set of exercises for recovery after hip arthroplasty is selected individually. It takes into account the following factors:

• patient's age;
• activity of the lower limb where the joint was replaced;
• the general health of the patient;
• psychoemotional state of the patient.

When performing physical exercises and while walking, it is important to remember that patients after hip arthroplasty are strictly prohibited from:

• crossing legs;
• flexion of the lower extremities in the hip joint by more than ninety degrees;
• twisting the leg to the side.

To make rehabilitation more effective, perform a set of exercises after hip replacement surgery:

1. Take a supine position (a firmer surface is ideal - an elastic mattress or floor), alternately perform a series of simple exercises:

• Bending the legs at the knee joint without lifting the foot from the surface.
• Abduction of the lower extremities to the side (alternately with a leg with an artificial and a natural joint).
• Bike. Raise your legs slightly up and perform movements that simulate riding a two-wheeled pedal vehicle.
• Alternate straightening and return to the bent position of the legs bent at the knees.

1. Change position by turning onto your stomach. In this position, do the following exercises:

• Flexion and extension knee joint.
• Raising the leg up.

1. Lying on your side, lift the straight lower limb up, and then take it to the side. Repeat the same exercise on the other side.
2. In a standing position, swing your legs forward, backward and abduct the lower limb to the side.
3. When performing this complex, do not make sudden movements so that the cup of the joint does not pop out, loosen, causing all sorts of complications and pain.

Rehabilitation centers and cost

For rehabilitation and getting rid of complications after arthroplasty, people often choose clinics abroad, preferring sanatoriums or clinics, for example, in Germany, Israel. But on the territory of Russia there are also medical centers where it is possible to undergo recovery after surgery, to cure the pathologies that have arisen after it. There are such clinics in major cities countries, for example, Moscow, Voronezh, St. Petersburg, where qualified doctors work who can assist in rehabilitation.

Price restoration measures after hip arthroplasty in different sanatoriums may differ depending on many factors:

• Hospital locations. In sanatoriums located in picturesque corners, the price per day will be much higher than in clinics located on the outskirts of the city.
• Services provided in the clinic. The larger the list of procedures, the higher the cost. Particularly relevant are massage, exercise therapy, exercise special simulators(for example, an exercise bike).
• The comfort of the wards or rooms directly affects the price of living in rehabilitation centers.

Sanatoriums, clinics and the cost of rehabilitation after hip arthroplasty in Moscow and St. Petersburg:

Video about rehabilitation methods

A course of rehabilitation in a clinic or sanatorium will help to cope with complications after hip arthroplasty. Medical institutions with experienced and polite staff, the latest equipment and the use of modern methods of recovery, there is not only in newfangled foreign health resorts, but also in Russian hospitals. Rehabilitation measures are aimed at reducing pain, improving general condition health, restoration of joint performance, generation of strength so that the implant can withstand certain loads.

For recovery after hip arthroplasty, methods are used, the effectiveness of which has been proven by many patients:

• Specialized massotherapy, aimed at postoperative recovery, relief of pain that arose after surgery.
• Electrotherapy - removes pain and promotes quick recovery.
• Laser therapy is a procedure that has a beneficial effect on the postoperative suture.
• Magnetotherapy - promotes tissue regeneration in the area of ​​surgical intervention.
• Adoption thermal waters, which contributes to the rapid recovery of the joints, improves their mobility and reduces pain.
• Therapeutic gymnastics, exercise, which is carried out to improve the motor activity of the leg, depending on the physical, psychological and emotional state patient, and is prescribed after a thorough examination.

To obtain the maximum result, it is necessary to use all methods in combination. Watch the video to learn more about the methods of dealing with the consequences after hip arthroplasty:

Hip arthroplasty surgery is an extremely complex intervention. Problems can lie in wait for doctors not only during the operation, but also after it. Complications after hip arthroplasty - this is what doctors who observe the patient fear with horror. And this is not surprising, because complications can negate many hours of intervention. Operations are especially difficult for older people with senile osteoporosis. They also constitute the main risk group.

Features of the development of negative consequences

Complications after hip arthroplasty occur in four percent of patients. This percentage cannot be called large; on average, it correlates with the percentage of complications during prosthetics in other joints. However, the percentage of complications does not decrease, although the prostheses themselves are constantly being improved, surgical techniques and experience is accumulating among surgical practitioners who are increasingly faced with the need to put prostheses in the hip joint.

Among the complications in patients are usually found (in descending order):

• purulent-inflammatory processes;
• dislocation of the head of the hip joint;
• periprosthetic fracture;
• neuritis peroneal nerve;
• pulmonary embolism.

It is interesting to note that the percentage of complications increases in proportion to the age of patients. For example, the least complications occur in patients under thirty years of age who underwent joint replacement. Most of the complications are in patients over 60 years of age, and this group is the leader in all types of complications. age category. Complications are predominantly recorded against the background of previously transferred diseases of the joint - coxarthrosis, aseptic necrosis, but the leader in this regard is the repeated replacement of the hip joint, which has become unusable.

The increase in complications is primarily due to the fact that in older patients, resistance to the development of infectious pathologies decreases, while at the same time, the number somatic diseases, why infections appear and the immunity of patients is weakened. Also, the risks of complications include:

• weakening of the reparative-restorative function;
• decline muscle tone, ligament strength;
• increase in osteoporosis.

All these factors contribute primarily to the appearance of purulent-inflammatory complications after surgery, as well as dislocation of the bone head.

REFERENCE! Pulmonary embolism and neuritis of the peroneal nerve appear as a result of repeated prosthetics, as well as if the prosthesis is performed with a severe injury to the proximal femur.

Repeated surgical interventions quite logically give severe complications because they are held in specific conditions, taking into account the fact that the anatomy of the joint is grossly violated, because the patient already has previously formed scars and adhesions that are re-injured.

Increased risk of complications in reoperation and if the patient has diabetes which greatly complicates the recovery process. If patients develop severe complications and it is impossible to return to normal life, their ability to work has suffered, then they are given disability, usually 2 or 3 groups.

The reasons

All causes of complications after joint arthroplasty are associated with several groups of causes. The first group is represented various reactions rejection - the legs hurt due to the non-perception of the prosthesis, an allergic reaction to the material from which the implant is made. The second group of causes is associated with the penetration of infection. It can be both negligence during the operation that provoked infection, and improper care for the patient, if he postoperative wound infection was introduced.

Reasons such as medical error, inadequate response body for anesthesia. Much less often, patients develop pulmonary embolism, but despite the fact that this complication is rare, it is quite formidable - thromboembolism can lead to sudden lethal outcome because the clot blocks the artery and causes ischemia and cardiac arrest.

If complications occur after arthroplasty, it is necessary to identify the cause of their occurrence in order to effectively fight against them. For the patient, the appearance discomfort and complications negatively affects not only physical condition but also depresses them emotionally. With the hope that they will be able to walk again and not experience difficulties, they again find themselves in a hospital bed with unclear prospects for the near future.

General complications

Hip arthroplasty is a complex surgical intervention. And it is such for both the doctor and the patient. Factors may arise on both sides, as a result of which, after surgery, there may be undesirable consequences. Among these are:

• an allergic reaction to medications that are given to the patient during surgery and at the premedication stage - usually such a complication occurs extremely rarely, since doctors find out in advance the patient's tendency to allergies, and if available, they give the safest hypoallergenic drugs. The same approach is used when applying anesthesia. However, the human body, even with relative health, may at any time inadequately respond to one or another medical preparation, therefore, such consequences of anesthesia appear;
• problems with the work of the cardiovascular system - in any case, during any operation, patients always undergo diagnostics, and first of all, the work of the heart. However, surgery and being in a state of narcotic sleep can negatively affect the work of the heart in the postoperative period, as a result of which the system may fail a year after the operation;
• signs of an allergic reaction to the implant material, as a result of which the person’s motor activity is impaired and the result of the operation, which was originally expected, was not achieved. In most cases, the reaction occurs to a ceramic prosthesis, but there is practically no difference between the manufacturer (domestic or foreign) - the percentage of rejections is the same.

infection

Infection of the implant site or the soft tissue incision itself is the most common type of complication. When infected, a strong pain syndrome occurs, and the pains are localized so incomprehensibly that patients sometimes cannot really explain exactly where it hurts - the place of the incision or inside the joint itself.

Infection can occur as a result of surgery

Pain after hip arthroplasty is so comprehensive that their localization is difficult. In the place of suppuration, hyperemia occurs, the leg swells. The thigh area becomes hot when touched.

The critical sign of infection is the inability of patients to walk. As a result of infection, the so-called septic instability of the joint develops. It is especially noticeable against the background of the patient's well-being, when after discharge he felt quite satisfactory, and after a while he could not stand on his foot, lameness develops and the patient complains of the characteristic symptoms of infection.

A vivid demonstration of the complication is the formation of a fistula. Usually the fistula appears in close proximity to the incision site. Since it is there that the purulent contents are easiest to find a way out. The edges of the fistula are uneven, edematous and hyperemic. Touch provokes pain, and purulent contents constantly leak out from the fistula in the thigh. Usually, patients develop a temperature after arthroplasty in case of infection, and with the appearance of a fistula, it decreases slightly.

Dealing with infection is not so easy, but it is quite real. Especially if the fight against infection is started on early stage and suppuration was detected in time. Patients are recommended to be treated with strong antibacterial drugs, drainage of the cavity is possible if an abscess has formed. Treatment with drugs is long, but in the end it allows you to achieve the desired and stop the inflammatory process.

Pulmonary embolism

If we talk about thromboembolism, then in this case the question arises not so much about treatment as about prevention. Thromboembolism is the most dangerous complication which causes instant death. In most cases, thromboembolism is the result of a long stay of the leg without movement. Therefore, doctors insist that early rehabilitation is an excellent way to prevent pulmonary embolism.

In parallel with these recommendations, doctors do not leave patients without medical support. Patients are given anticoagulants that prevent the formation of blood clots. The patient should take them for several weeks until he begins to actively move and active blood supply to the limb resumes.

Massive blood loss

There is a risk of bleeding during any operation, but it is especially high with hip replacement, since doctors work in close proximity to large main vessels.

IMPORTANT! In ordinary life, if such a vessel is damaged, mortality occurs in 4-5 minutes.

Doctors have every chance to stop the bleeding that occurred during the surgical intervention, but all this negatively affects the patient's health. Major bleeding can be provoked not only by a doctor's mistake and damage to the vessel, but also by the patient's inadequate response to anticoagulants. There are cases where even usual dose anticoagulant, the patient has an inadequate reaction and massive bleeding begins. Therefore, during the operation, the doctors prepared blood for transfusion.

Dislocation

The appearance of dislocation of the endoprosthesis head is one of the most serious complications after infection. The dislocation is connected with the fact that the prosthesis of the hip joint is still a foreign body, therefore it does not have the anatomical functionality that the bone head had.

Dislocation can happen at any time - both in the first weeks after surgery, and later. A fall, a sharp turn of the leg, and even performing a complex exercise in the rehabilitation process can provoke a dislocation. In order to avoid dislocation, doctors give the most complete recommendations to patients on how to properly walk, sit down and even sleep with a hip replacement.

After the operation, in the first few weeks, patients are engaged with an exercise therapy specialist who will help strengthen muscles and form the correct motor skills for such patients. For example, patients are not recommended to bend the leg at the hip joint at a right angle - the doctor will teach the patient how to get by with other exercises for specific purposes.

Structural loosening

Late complications after arthroplasty may manifest as loosening of the structure. This happens as a result of the active activity of the lower extremities.

The cause of loosening may be a negative reaction to the installed implant

And although sports are prohibited for such patients, even everyday physical activity can lead to loosening of the endoprosthesis. This phenomenon, of course, negatively affects the state of the bone tissue.

In the process of loosening, the destruction of bone tissue begins in the place where the implant is attached. Instability in this area may not even be noticeable at first, but patients involuntarily transfer the load of the body to the knees, as a result of which the knee hurts on the side of the prosthesis. At any time, a loose joint can provoke a fracture, so doctors insist on reducing the motor activity of patients with endoprostheses. Otherwise, re-arthroplasty is performed.

Lameness

Statistics note that in almost all patients after endoprosthetics, gait changes. For some, it can even turn into a noticeable limp, significantly affecting how the person moves. This appears as a result of the following reasons:

• shortening of the leg, which often occurs after prosthetics;
• prolonged immobilization of the limb, as muscle contracture develops.

If the lameness has developed palpable and it is completely uncomfortable for a person to walk, then he can undergo an operation to build up bone tissue to equalize the length of the operated leg with the healthy one. With a slight difference in the length of the legs, the problem will help to eliminate the insoles that are placed in the shoes, as well as the manufacture orthopedic shoes on custom order with specially prepared heels of different heights. You will have to wear such shoes for the rest of your life.

Soreness in the groin

In rare cases, patients may develop a complication such as pain in the groin. Such discomfort appears either in the first days after the operation, or some time after. Pain in the groin is very annoying to patients, so they turn to doctors.

The cause of pain may be an allergic reaction to the metal or ceramic from which the product is made. Pain also appears if the implant is placed in front of the acetabulum. Usually patients successfully endure this complication and first of all therapeutic exercises help them.

It can be performed on initial stage in special rehabilitation groups of exercise therapy, where the patient will need to go after surgery. And in the later stages of rehabilitation, patients are recommended to visit the pool, where the restoration of the hip joint takes place as comfortably as possible and without increased load. If after some time the discomfort does not go away, re-arthroplasty is performed.

Swelling of the lower extremities

Unpleasant symptoms after surgery may be supplemented by manifestations of swelling. Swelling of the leg develops due to the long stay of the limb in one position. This complicates the metabolism and, first of all, the metabolism of fluid, it is difficult to remove it from the body, from the limbs along the periphery - and even more so.

ADVICE! Eliminate swelling of the legs will help drugs of the diuretic group - diuretics. With their help, water is removed from the body in a larger volume, and the cells begin to absorb it even in hard-to-reach places.

To get rid of puffiness, patients may be advised compression stockings, which are worn on the leg for a while and attached to the limb exalted position. You can also use compresses and do elementary exercises regularly to avoid congestion.

Physiotherapy

To prevent negative consequences must be carried out therapeutic gymnastics. It improves tissue nutrition and promotes speedy recovery. The stages of rehabilitation include various sets of exercises. At the initial stage, patients perform simple moves that are possible in their condition, and then doctors include complex exercises in rehabilitation that will help patients adapt to real life conditions - sit down correctly, go down stairs, get out of bed, etc.

Rehabilitation after surgery is carried out under the supervision of specialists

If the development of the joint is successful, then in the end, patients can do without crutches and move independently. This is very important for edema and muscle contracture, which can delay the rehabilitation process for a long time.

Exercises for patients are selected taking into account the following factors:

• patient's age;
• previous activity of the leg in which the hip joint was replaced;
• health status after surgery;
• psychological attitude of the patient to rehabilitation.

Doctors give guidance not only on what can be done and what activity will benefit, but also warn patients about what absolutely should not be done:

• cross legs;
• bend the joint in the thigh more than a right angle;
• twist the limbs to the side.

For rehabilitation, patients are shown feasible physical activity:

• in the supine position, it is necessary to bend the legs at the knees without tearing off the foot, take the legs to the sides, do the “bicycle” exercise;
• lying on your stomach, bend your knees, lift up and take to the side;
• lying on your side, alternately on both sides take your legs to the side;
• in a standing position, perform leg swings, gradually increasing the range of motion.

If during the exercise the legs begin to hurt, physical activity it is necessary to reduce and consult a doctor about possible violations.

Endoprosthetics of the hip joint is an extremely complex and difficult operation for the patient. Recovery after surgery is long, and the most important thing at the stage of rehabilitation is to do everything possible so that patients do not have complications after surgery.

Hip arthroplasty is an operation to replace the affected joint with an endoprosthesis. As with any other surgery, complications can occur. This is explained individual characteristics organism, state of health and complexity of the operation.

Pain after arthroplasty is inevitable. This is due to the nature of the operation.

Risk factors

• The advanced age of the patient.
• Associated systemic diseases.
• Transferred operations or infectious diseases history of hip joint.
• Availability acute injury proximal femur.

Many patients are afraid to undergo surgery due to possible complications.

Possible Complications

Rejection of a foreign body (implant) by the body

This consequence occurs extremely rarely, because Usually, before the operation, after choosing the prosthesis, tests are carried out for individual sensitivity to the material. And if there is intolerance to the substance, then another prosthesis is selected.

The same applies to allergic reactions to anesthesia or the material from which the prosthesis is made.

Infection in the wound during surgery

This is a serious condition that needs to be treated. long time with the help of antibiotics. Infection can occur on the wound surface or in the depth of the wound (in soft tissues, at the site of the prosthesis). The infection is accompanied by symptoms such as swelling, redness, and pain. If treatment is not started in time, then the prosthesis will need to be replaced with a new one.

Bleeding

It can begin both during the operation and after it. main reason is a medical error. If timely assistance is not provided, then the patient, in best case, a blood transfusion may be needed, at worst, hemolytic shock and death will occur.

Prosthesis displacement

Change in leg length

If the prosthesis has not been fitted correctly, the muscles near the joint may weaken. They need to be strengthened, and exercise is the best way to do this.

The risk of complications is reduced with proper rehabilitation after arthroplasty surgery

Deep vein thrombosis

After a decrease in motor activity in the postoperative period, blood stasis may occur, and as a result, the occurrence of blood clots. And then it all depends on the size of the blood clot and where it will be carried by the blood stream. Depending on this, the following consequences may occur: pulmonary thromboembolism, gangrene of the lower extremities, heart attack, etc. To prevent this complication, it is necessary to begin to be active at the appointed time, and on the second day after the operation, anticoagulants are prescribed.

Also, over time, the following complications may occur:

• Weakening of the joints and disruption of their functioning.
• Destruction of the prosthesis (partial or complete).
• Dislocation of the endoprosthesis head.
• Lameness.

These complications after hip arthroplasty occur less frequently and over time. To eliminate them, you need surgery (replacement of the endoprosthesis).

Pain after hip replacement

The only complication that will accompany arthroplasty under any conditions is pain.

To get to the joint, it is necessary to cut the fascia and muscles of the thigh. After stitching, they will grow together for about 3-4 weeks. When performing movements, pain will occur. And since the movements are mandatory so that the muscles grow together faster and correctly, the pain will be felt for almost the entire period of rehabilitation.

Endoprosthetics is a serious operation. After it, certain complications are possible, but with timely diagnosis and treatment, everything can be eliminated without unnecessary harm to health.

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

AT recent decades total arthroplasty is becoming one of the main methods of treatment of severe pathological changes of the hip joint, allowing to restore the hip support, achieve a sufficient range of motion, relieve the patient of pain, lameness, and return him to an active lifestyle.

Application modern technologies made a significant leap in joint prosthetics. Using implants latest generations, many authors note a significant increase in the period of their "survival".

Up to 1,500,000 total hip replacements are performed annually worldwide.

Endoprosthesis statistics

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

The use of joint arthroplasty in each specific case makes it possible to solve complex problems optimally speedy deliverance from pain, restoration of mobility in the affected joint and limb support, return the ability to self-service.

Despite recent successes surgical treatment, according to foreign sources for the observation period after 1 year and 5 years, positive results after arthroplasty are noted in 76–89% of cases. In patients with a unipolar endoprosthesis pathological process, as a rule, progresses due to abrasion of the cartilage of the acetabulum and leads to a deterioration in the function of the limb and the appearance of pain. In some patients after total arthroplasty in remote period pain syndrome also appears due to various reasons.

One of the reasons that significantly reduces the "quality of life" of patients is pain after hip arthroplasty.

Even experienced doctors far from always being able to differentiate pain, prescribe adequate treatment without knowing the clear etiopathogenesis of the pain syndrome in each case.

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

The appearance of pain in the inguinal and gluteal regions, their intensification in the patient's sitting position, most often indicate the interest of the acetabular component of the endoprosthesis.

Pain along the anterior surface of the thigh and in the inguinal region, especially aggravated by load and rotational movements, indicate the instability of the femoral component of the endoprosthesis. Usually, the pain associated with developing instability radiates to the knee joint, as in coxarthrosis.

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

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

Used to prevent infection standard methods, but at differential diagnosis causes of pain syndrome, it is important to take into account the presence of infectious processes (upper and lower respiratory tract, infectious lesions teeth) in the distant postoperative period as a possible probability of hematogenous dissemination of infection into the joint.

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

Currently, the problem of pain syndrome of the hip joint after arthroplasty with the exclusion of the causes discussed above remains insufficiently studied, as evidenced by a small amount of literature data. In authoritative editions of the world literature, there are mainly references to the presence of pain, while their etiology and pathogenesis have not been studied.

Data of foreign authors

According to foreign authors, the pain syndrome in patients undergoing total hip arthroplasty remains in 17-20%, and 32-35% have new sensations from mild pain or discomfort in the hip joint to severe pain in the absence of instability and infection. process.

According to the results of the final reports of the Swedish Register for 2002-2006. The causes of revision hip arthroplasty in 1.2% of cases are pain.

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

According to reports from the Danish Endoprosthetics Registry for 1998-2003. in 3.2% of patients 6 months after the operation, severe pain appears.

According to the research of the orthopedic clinic in Salt Lake in 2004, in most cases, the pain syndrome after primary arthroplasty occurred against the background of excessive offset, which subsequently led to the development of tensopathy or trochanteritis. According to our research, with excessive offset, patients complain of pain of a pulling nature in the projection greater trochanter and wings ilium, aggravated by flexion and adduction. In more severe cases, there was an abduction contracture. In addition, when installing an endoprosthesis stem with insufficient offset, the localization of pain is identical, but their intensity is more pronounced, associated with muscle tension, up to muscle spasm, as more effort is needed to keep the pelvis in the correct position. At the very least, developed positive symptom Trendelenburg.

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

In addition, according to the Australian orthopedist J. Herald, stenosis of the upper and lower gluteal arteries often occurs after hip arthroplasty, and this causes pain in the inguinal region.

European authors described pain in the inguinal region after arthroplasty, which is associated with tension or damage and trauma to m.iliopsoas. In the first case, pain occurs when the lower limb is lengthened. In the second case, the endoprosthesis cup, if it is not covered, contacts the m.iliopsoas fibers, causing their damage.

This results in pain in the groin during flexion and external rotation. According to the observations of the authors, in 62% of cases, pain occurs when cement plant cups.

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

Pain may occur if the femoral component is incorrectly installed.

Installation of the endoprosthesis stem in the varus or flexion position causes pain along the anterior outer and posterior surfaces of the thigh in the projection of the distal end of the endoprosthesis stem. The pain increases with the load on the limb, gradually becoming more pronounced and intense. On the radiograph of the proximal femur against the background of the varus position of the endoprosthesis, hypotrophic, less often hypertrophic (stress schilding) changes in the cortical bone at the site of local contact with the pedicle are determined.

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

Other pain factors

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

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

Such pains are characteristic symptom both for the disease of the hip joint in general, and in the immediate period after its arthroplasty. Most often, this symptom is noted in unipolar endoprosthesis.

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

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

Thus, due to insufficient consideration of this problem in the literature, the creation of algorithms for diagnosing and preventing pain after hip arthroplasty is relevant and of great interest, since it is pain relief that is the dominant motive in the patient's consent to surgical treatment.

At present, due to the wide development of arthroplasty in the world, the priorities regarding the results of the operation have changed.

According to leading experts in this field, it is the improvement of the "quality of life" of patients that is main goal endoprosthesis.

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