(A) Guidelines for patients undergoing artificial hip joint replacement surgery
I. What conditions are suitable for hip replacement surgery?
(1) various inflammatory arthritis of the hip joint, including primary or secondary osteoarthritis, traumatic arthritis, rheumatoid arthritis, hemophilic arthritis, Charcot arthritis, etc.; (2) femoral head necrosis; (3) congenital hip dislocation or subluxation, acetabular dysplasia; (4) hip fusion or pseudarthrosis formation; (5) periprosthetic hip joint tumor; (6) resting infectious arthritis (including tuberculosis); (7) failed repair after hip reconstruction surgery.
B. What circumstances contraindicate hip replacement surgery?
(1) recent and current infection in the hip joint and infection in the distant part; (2) unstable medical condition.
Third, the advantages and disadvantages of artificial hip joint its advantages are.
(1) Mature surgical technique. (2) The surgical treatment period is relatively short, about one month. (3) The joint pain can be completely removed.
The disadvantages are: (1) It has an impact on sports such as running and hiking. (2) Sitting on a low stool and squatting completely should be avoided after surgery. (3) After 10-15 years after surgery, there may be loosening between the bone and the artificial joint, and the percentage of replacement is about 5-10%. (4) It is very difficult to treat infections in artificial joints. 1% of people have infections after surgery, which require prolonged treatment or even removal of the artificial joint, and joint replacement after the infection is controlled. The infection rate of the re-surfaced joint is higher than that of the first operation. (5) Wear and loosening of the artificial joint is also a cause of post-operative pain and surgical failure. (6) The price is more expensive.
Fourth, how to choose a good artificial hip joint?
When patients decide to use artificial joint replacement treatment, a question often comes up: what kind of artificial joint is the best artificial joint? It should be said that different patients should choose different artificial joints. Artificial joint prosthesis has very strict requirements on its design, surface treatment, material selection, manufacturing process and packaging; it also needs sufficient clinical practice to prove the effectiveness of a certain artificial joint. At present, the artificial hip joint has become a very mature artificial joint, both in terms of the prosthesis itself and in terms of surgical techniques. The artificial hip joint has been widely used in clinical practice and has achieved good clinical results. The choice of artificial hip prosthesis is very different from the choice of other commodities, because once the artificial hip prosthesis is placed in the human body, it is not easy to “replace”, even if the “replacement” cost is also quite large, it can not be measured with money. Therefore, the choice of a good artificial joint should be made carefully under the guidance of experts.
V. Post-operative examination
Three months after discharge to the hospital to review, take X-rays, to understand the position of the joint prosthesis and stability is good. Six months after the operation and then re-examined once, and every year after that, the film should be examined. If there is discomfort, such as redness, swelling, pain or difficulty in moving the joint, or if the joint is injured due to an accident, go to the hospital in time for examination.
Sixth, the duration of use and efficacy of the artificial hip joint
The hip joint is an important joint, which has various functions such as walking, running, jumping and squatting. Once the hip joint is diseased, the cartilage of the joint will be destroyed, and the surface will turn from smooth like a mirror to rough or even defective, and furthermore the bone will be deformed. As a result, you will feel pain, have difficulty walking, limited movement, and limp. When the disease progresses to a certain level and the joint is destroyed, surgery is required. An artificial hip joint is used to replace the damaged joint to restore walking and other functions. The greatest benefit of artificial joint surgery is that it can eliminate joint pain after surgery, greatly improve the function of the joint, and improve the patient’s quality of life so that he or she can work and live well during his or her lifetime. Successful arthroplasty allows you to live a pain-free life and perform daily activities that no other treatment can achieve for a damaged hip joint. Nowadays, more and more patients are willing to accept the suggestion of artificial joint surgery. The longevity of the artificial hip joint is determined by two factors: the wear and tear of the joint and the loosening of the prosthesis due to wear particles. The strength and wear resistance of the artificial hip material can generally satisfy the patient for more than 20 years. Nowadays, the artificial joint can be used for more than 95 percent of the twenty years. Of course, the service life of the artificial joint is also related to many factors, such as the amount of movement of the patient, the choice of artificial prosthesis, the surgeon’s surgical technique and their own conditions.
VII. Treatment of artificial hip joint after loosening or infection
Once the artificial hip joint becomes infected or aseptically loosened, joint revision surgery is required. There are specially designed hip prosthesis and surgical instruments for revision surgery. The revision surgery is more complex than the initial surgery and may require bone grafting, a different type of joint prosthesis, or the use of a special prosthesis. After revision surgery, the majority of patients can achieve a satisfactory outcome.
VIII. Protection after artificial hip arthroplasty
After the artificial hip replacement, you need to develop good habits of life and activities to maintain the stability of the joint, and learn some simple rehabilitation knowledge and carry out joint rehabilitation exercises. Pay attention to the prevention and control of infections, and actively treat infections such as tonsillitis, skin infections, tinea capitis, etc. After surgery, you can do exercises such as cycling, walking, dancing and swimming, but strenuous exercises such as running and jumping, as well as long-distance walking and climbing are not encouraged. In addition, some hospitals provide patients with post-operative rehabilitation manuals for their reference.
IX. Rehabilitation after hip replacement surgery
Rehabilitation exercises are crucial to the success of total hip replacement surgery. Isometric contraction of the muscles of the affected limb can be performed after surgery. If the joint position and fixation are good, rehabilitation exercises can be started under the guidance of doctors and rehabilitation teachers, even after complete rehabilitation and discharge from hospital, regular rehabilitation exercises are required. For details, please refer to “Rehabilitation Guideline for Hip Joint Replacement Patients”.
(B) Pre-surgical preparation for the artificial hip replacement process
(1) Routine preoperative examination: electrocardiogram, chest X-ray, blood and urine routine, blood biochemistry, infectious diseases, coagulation function, blood type.
(2) Special examination: orthopantomogram of pelvis, CT and 3D reconstruction of hip joint if necessary.
(3) Common medical conditions examination and treatment: hypertension, diabetes mellitus, coronary heart disease, thrombotic disease; long-term medication registration.
(4) Search and treatment of systemic infectious lesions: tinea pedis, skin infection, etc.
(5) Hip function score before surgery.
(6) Patient education, artificial joint material selection: imported, domestic, polyethylene, ceramic, metal.
(7) Judgment of affected hip characteristics: conventional hip replacement, hip joint ankylosis, fixed external rotation deformity of hip joint, soft tissue contracture in front of hip joint, hip dysplasia, bone defect repair, revision. Rheumatoid, Parkinson’s disease, acetabular deformity, femoral deformity.
(8) Design the osteotomy line according to the template drawing.
Surgical routine
(1) Preoperative skin preparation, alcohol disinfection of the hip joint and sterile towel dressing.
(2) Intraoperative intravenous antibiotics.
(3) For those with a history of thrombotic disease, low molecular heparin is routinely used preoperatively.
(4) Leave negative pressure drainage.
(5) Arrange a 100-level laminar flow operating room.
(6) The operator should have a double hand glove, control the visitors and movement in the operating room, and rinse extensively before closing the incision.
(7) Normal acetabular prosthesis position: 40-45 degrees of abduction and 10-25 degrees of anterior tilt. The femoral prosthesis is tilted 15 degrees anteriorly.
(8) Pay attention to the restoration of bilateral lower limbs of equal length, the stability of joint resistance to dislocation, and the stability of prosthesis installation.
Postoperative treatment
(1) Use equipment to improve blood circulation in the lower extremities; (2) Pay attention to body position to avoid joint dislocation; (3) Leave negative pressure drainage for about 3 days and remove it when the 24-hour drainage is less than 25 ml; (4) Exercise the isometric contraction of lower extremity muscles on the day of surgery; (5) Use intravenous antibiotics for 3-5 days; use low-molecular heparin for 7-10 days if there is a history of thrombotic disease; generally do not use hemostatic drugs. (6) Review blood picture, sedimentation and CRP at 1 day, 1 week and 2 weeks after surgery; (7) Crutches and X-rays at 4-14 days after surgery, and stitches removed at 10-12 days after surgery; (8) Further rehabilitation training is described in the “Rehabilitation Guideline for Hip Replacement Patients”.
(C) Rehabilitation guidance for hip replacement patients
After artificial hip joint replacement surgery, correct exercise, reasonable use, careful protection and regular review should be achieved.
After the artificial hip joint replacement surgery, the pain of the hip joint will gradually decrease, the strength will gradually increase, the range of motion will gradually increase, and the local swelling will also gradually subside. However, this is a gradual process and the speed of recovery varies from person to person; it is also different for the left and right side of the same person. Generally speaking, the best recovery will be achieved about 1 year after the surgery.
Correct exercise.
After the artificial hip replacement surgery, the main exercise is the lateral leg lift exercise. That is, lying on your side, with the affected side above you, forcefully unfold the hip joint to lift the lower limb from the side. The purpose of this exercise is to strengthen the abductor muscles of the hip joint so as to make the hip joint stronger and more stable, and to reduce the wear and tear of the artificial joint.
The rehabilitation process may be accompanied by mild pain in the muscles and ligaments around the hip joint. Daily adherence to home physical therapy can help relieve pain and increase the effect of exercise rehabilitation. This is done by applying fotarine cream (diclofenac sodium cream) to the painful area and then drying it with warm air from a hair dryer for 5-10 minutes each time, 3-6 times a day.
Reasonable use.
Artificial hip joints have the potential to wear out and loosen after long-term use. To prolong the service life, it is not recommended for patients to engage in heavy physical work, as well as strenuous sports. However, it is possible to perform normal sports and work adequately.
After the artificial hip joint replacement surgery, especially within 3 months after the surgery, excessive flexion and inward movement of the hip joint may lead to dislocation of the artificial joint. Therefore, it is important to avoid excessive hip flexion and inversion activities after surgery; when lying on your side, you can put a thick pillow between your legs; after surgery, it is generally recommended to use a toilet seat, not squatting, and not to sit on a small stool.
Careful protection.
Careful protection is mainly reflected in two aspects: one is to prevent infection and inflammation; the second is not to prevent traumatic fracture.
Infection and inflammation of the artificial joint may still occur in the later stage because the bacteria from other parts of the body may be transferred to the location of the artificial joint, resulting in infection and inflammation. Therefore, it is important to treat infections in other parts of the body (such as colds, pneumonia, boils, etc.) promptly and effectively. In the event of infection and inflammation of the artificial joint, early and decisive surgical treatment is necessary to preserve the artificial joint, otherwise, the artificial joint must be replaced in two stages of surgery.
When a traumatic fracture occurs around an artificial joint, the fracture does not heal easily and can easily lead to loosening of the artificial joint. Therefore, it is important to pay more attention to the prevention of trauma in general.
Regular review.
Early after the surgery, you should review regularly, usually once every 1-2 months, so that the doctor can guide the patient’s rehabilitation exercises. After the condition is stable, it is enough to review once a year.
1. 0-3 days after surgery (mainly rest and pain relief), active or passive movement of the ankle joint (10 times per hour of flexion and extension activity), isometric contraction exercise of the lower limb muscles (see later), and use of special equipment to improve blood circulation in the lower limb.
On the day of surgery, the lower limbs were slightly padded so that the hips and knees were slightly flexed, with thong shoes and triangular pads between the legs.
On the next day of surgery, remove the pad to straighten the lower limbs.
2.3-14 days after surgery (restoration of joint range of motion mainly, followed by restoration of muscle strength), according to the body’s tolerance to support the crutches to the ground, gradually increase the range of motion. For those who use bone cement prosthesis, decide the degree of weight bearing according to your tolerance; for those who use non-bone cement prosthesis, partial weight bearing within 6 weeks; for those who use bone implant, extend the time of partial weight bearing according to the situation.
Hip flexion exercises.
Bed rising exercises.
Seated hip extension in bedside position.
Sitting rotation exercise.
3.2-4 weeks after surgery (mainly to enhance muscle strength) lower limb muscle strength exercise. (See after) Remove the stitches and can be discharged from the hospital.
Up and down step exercises. (Good leg goes up first, bad leg goes down first.) For those who have conditions, pedaling exercises are available. (First practice back pedaling, then practice front pedaling) 4. Continue muscle strength exercise more than 4 weeks after surgery. (See later) Gait balance exercise.
If possible, continue pedaling exercises.
Prevent joint dislocation and limit the activities of large angles such as hip joint cross-leggedness and overflexion.
Quadriceps (anterior thigh muscles) strength exercise method.
Start with the knee joint flexed in the seated position, or supine position with the knee joint padded. Straighten the knee and keep it straight for 5 seconds, then relax and let the knee flex on its own, count the 1st time in your mind; then straighten the knee again and keep it straight for 5 seconds, then relax and let the knee flex on its own, count the 2nd time in your mind; …… until you rest after 10 exercises. The total number of exercises per day varies depending on the individual, generally 250-300 times. When you feel that this exercise is easier, you can tie a 1 – 2 pounds of sandbags at the ankle.
National rope muscle (rear thigh muscle) strength exercise method.
At the beginning, prone position will be straight knee joint. The knee joint will be bent hard, and keep the hard bending state 5 seconds after relaxation, let the knee joint straight, the heart silent count for the first time; then again the knee joint hard bending, and keep the hard bending state 5 seconds after relaxation, let the knee joint straight, the heart silent count for the second time; …… until exercise 10 times after rest. The total number of exercises per day varies according to individual circumstances, generally 250-300 times. When you feel that this exercise is easier, you can fix a leather band at the foot of the bed, hook the ankle to the band and exercise the flexion knee joint.
Lower limb muscle isometric contraction exercise method.
The “lower limb muscle isometric contraction” is to make all the muscles of the lower limb tense, but the joints of the lower limb are not contracted by muscle extension and flexion activities. This exercise method is usually used in the early post-operative period, and usually does not lead to increased pain and bleeding.