After endoprosthetics of the hip joint, the leg was swollen
More recently, many patients witharthrosis of the hip joint (coxarthrosis), or fractured neck femora, were doomed to complete disability due to loss of ability to move independently. Fortunately, the introduction of new technologies in medicine has allowed patients to avoid this fate, and to live up to their previous full life. One of these technologies is total hip replacement (TETS), when the entire hip joint (head, neck of the hip, cartilage surface of the acetabulum) is replaced with a synthetic prosthesis. But in order for the synthetic joint to work just as well as "the native one", it is important not only to carry out the operation at a class level. It requires competent postoperative recovery or rehabilitation after endoprosthetics. And it depends not only on the doctor, but also on the patient.
The TETS itself is rather complicated intechnical plan and a traumatic operation. The skin and muscles are dissected, the bone-cartilaginous tissues of the worn out joint are removed. Then the leg of the prosthesis is fixed in the canal of the femur. Severe operating injury is accompanied by pain, the release of biologically active substances from tissues to the blood. In turn, this leads to a change in the functioning of the heart, lungs, coagulating blood system. Preoperative preparation and anesthesia eliminate all these negative consequences, but only to a certain extent.
It goes without saying that people go toendoprosthesis, to put it mildly, not from a good life. Strict indications are needed for such an operation. Such indications include the destruction of joint structures due to coxarthrosis or hip fracture. With coxarthrosis, due to long-term motor disorders, atrophic changes in the muscles of the lower limb and back are developed, and the work of the pelvic organs is disrupted. The load on the spine increases, which leads to the development of lumbosacral osteochondrosis and radiculitis.
Do not forget that the vast majorityof patients operated on for TETS - people of elderly and senile age. This means that they have varying degrees of disability in the functions of the heart, respiration, and endocrine system. In some patients, the disorders are decompensated, and after the operation are aggravated. In addition, the operation itself and the postoperative bed regimen lead to disruption of the peristalsis (contractions) of the intestine until the development of atonic intestinal obstruction. It should not be forgotten that in the elderly, the ability to regenerate, heal damaged tissues during surgery, is significantly reduced. Immunity is weakened, resulting in favorable conditions for infection.
Thus, postoperative problems after hip replacement are as follows:
- The patient is concerned about postoperative pain
- The existing muscle atrophy is aggravated
- Cardiopulmonary insufficiency is aggravated
- Violated work of the intestine
- Great danger of cerebral strokes because of blood pressure jumps
- Violations of blood clotting can lead to thrombosis of the veins of the lower extremities and to an extremely difficult condition - pulmonary embolism
- Postoperative wound can serve as an entrance gate for infection.
Measures to restore motor functions andprevention of postoperative complications are complex. Needless to say, the main emphasis is on curative physical training (LFK), which is designed to ensure the optimal operation of the newly acquired joint and the entire lower limb. In addition to exercise therapy, other therapeutic measures are carried out using drugs from various groups, as well as physiotherapy procedures.
And the first such action ispostoperative analgesia, during which they combine non-narcotic (Renalgan, Dexalgin) and narcotic drugs (Morphine, Promedol). To prevent severe pulmonary heart failure, patients are prescribed cardiac remedies (Mildronate, Riboxin, ATP). This patient shows inhalation (inhalation) of oxygen. Oxygen in a moistened form is fed through a special breathing apparatus.
Another important point is preventionthrombotic complications, which often develop in patients in old age after surgery. At the same time, in the veins of the lower extremities, the parietal thrombi form, which, when detached, are brought into the pulmonary artery by a current of blood and clog it. Blockage of the main trunk of the pulmonary artery can cause instant death. To prevent this from happening, in the first few days after the operation, such patients are bandaged with an elastic bandage and subcutaneously injected with funds preventing blood clotting (Fraksiparin, Clexan). To eliminate postoperative atony of the intestine, assign injections of Proserin, Ubretid. Necessarily prescribe antibiotics (Ceftriaxone, Metrogil).
There is an erroneous opinion that LFK afterendoprosthetics of the hip joint can be performed only in the late postoperative period, and in the early days you need a strict rest. This erroneous tactic can lead to contractures (persistent limitations of the volume of movements) and to thrombotic complications. Therefore, some, the most simple loads, are carried out already in the first day after the operation, on leaving the anesthesia. In the exercise of exercise therapy should be observed the principle of phase, when the exercises themselves are done in several phases.
Zero phase - in the first day after the operation, when the following types of exercises are performed:
- Bringing and moving the foot up and down several times every 10 minutes. - the so-called. foot pump
- Rotations in the ankle in both directions 5 times
- Short-term, for 10 min, the tension of the anterior quadriceps femoris
- Flexion of the knee with simultaneous tightening of the heel
- Shortening of the buttocks followed by a voltage for 5 seconds
- Retracting the operated leg to the side and returning to its original position
- Raising the straightened leg for a few seconds.
The first phase, 1-4 days after surgery - the so-called. strict care. At this time, you are allowed to sit on a hospital bed or chair, and then move with crutches or special walkers. Important: when planting, do not bend the limb in the hip joint more than 900, do not cross the legs. On the contrary, lying on the bed, try to take your foot to the side. For this, you can put a pillow between your legs. The main types of exercises in this phase are performed in a standing position:
- Bending of the leg in the knee and hip joints
- Straightening of the leg in the hip joint and drawing it back
- Putting your foot to the side.
The second phase of rehabilitation or deceptivePossibilities - 5 days - 3 weeks after the operation. Many patients at this time feel a surge of energy, they were tired of stiffness and inaction. But the joint is not yet strong, and muscle atrophy persists. This phase shows the movement loads - movement on a horizontal surface, but not more than 100-150 m. or climbing and descending the stairs. Climbing the stairs, you should lean on a cane or on a crutch. At the same time, at the higher step, first put a healthy leg, then operated on, and then - a cane. When descending the stairs, everything is done in the reverse order.
The third phase of rehabilitation, the "beginning of work"after 1-2 months. after operation. At this time, the implanted joint "caught on", and the muscles and ligaments are so strong that you can smoothly increase the load, and carry them out at home. Exercises in this period are similar to the previous ones, but they are performed with burdening. As a weigher, an elastic band can be used. One end of the tape is tied to the operated leg at the ankle level, and the other to the fixed object, for example, to the door handle, followed by bending, straightening and retraction.
During this period, you can increase the durationwalking tours - half an hour 3-4 times a day. Even exercises on a stationary bike are shown. In this case, do not forget one rule - the emergence of pain is a signal to stop training. At the same time, do not stay for more than an hour, sit in a fixed position. The above rule of the right angle must also be observed. In general, during each hour should be a little, for several minutes, walk around.
In the course of rehabilitation after endoprosthesis replacement therapynecessarily combined with physiotherapy procedures, among them - darsonval, phonophoresis, magnet, amplipulse. Thanks to these procedures, the edema is finally eliminated, the muscles are stimulated. The final stage of rehabilitation of hip arthroplasty is a stay at mud resorts.