Rehabilitation of orthopedic patients after hip replacement

A comparative analysis of the treatment of 120 patients after endoprosthesis for degenerative-destructive diseases of the hip joint was carried on. All the patients were divided into two groups: the main group included 74 patients who underwent a full course of rehabilitation, the control group consisted of 46 patients without rehabilitation. The results of a comparative assessment of the static-dynamic function in the two groups of patients after operation of endoprosthesis have shown the inclusion of an obligatory program of rehabilitation to be expedient for the restorative treatment in addition to the operation of endoprosthesis.     

Approaches to objective assessment of the individual weight bearing in patients after total endoprosthesis of the hip joint

An algorithm for the detection of weight bearing on the lower extremity after total endoprosthesis of the hip joint was developed, taking into consideration the parameters of the morphometric structure, type of pathology, method of treatment, the resulting extremity functioning and social and every-day conditions. The individual rehabilitation measures after endoprosthesis were performed in three steps and corrected depending on changes in the parameters in question. The amplitude of movements in the joint after using the method of calculation of the weight bearing on the lower extremity became close to normal in 26 patients after completion of the rehabilitation course and the statistic-dynamic indices of the extremity became stable.     

Rowing with an endoprosthesis of the hip (author's transl)

After inserting an endoprosthesis of the hip sports activities are mandatory to restore and maintain joint function. Rowing is compared with other disciplines as a most suitable sport. It entails all the advantages which are beneficial to patients with a hip endoprosthesis and should be generally adopted as an appropriate rehabilitation measure.     

The limits of fluctuations of the laboratory findings in the preoperative period during uncomplicated revision endoprosthesing of the hip joint

The revision endoprosthesis of the hip joint for aseptic loose components was performed in 482 patients (297 women and 185 men). Before operation the assessment of 44 laboratory indices was made which included clinical blood tests, investigation of the coagulating system, protein and mineral exchange, enzymatic activity and other biochemical criteria. The postoperative course was even, without variations. The work shows the limits of deviations of the parameters with respect to normal condition and gender. The authors believe that they can be considered as a variant of the clinically adequate reaction rather than as a criterion of the unfavorable prognosis of the postoperative course.     

Operative treatment of femoral neck fractures in elderly patients

Experience of the hip joint endoprosthesis for the femur colli fracture in 186 elderly patients is presented. The hip joint endoprosthesis expediency and its advantages in comparison with the femur osteosynthesis were substantiated.     

First experience of the hip joint prosthesis using DePuy ASR system

The system of the hip joint total endoprosthesis DePuy owes undoubted advantages over standard metal-polymer systems and constitutes the optimal one on the modern stage of endoprosthesis development for young patients, it permits to escape the revision prosthesis. Early return of the patients to labour activity and short period of adaptation constitute economical efficacy of the construction applied.     

Gastroduodenal ulcers in the practice of joint endoprosthesis

The gastroduodenal ulcer rate and the gastrointestinal hemorrhage occurrence probability after total endoprosthesis of the hip and knee joint were studied. Of 526 patients in 4 (0.7%) after the total joint endoprosthesis operation the gastroduodenal ulcer had occurred, demanding the urgent treatment measures conduction. It is mandatory to conduct an adequate prophylactic measures to the patients, suffering pronounced gastropathy, according to anamnestic data available.     

Reactivation of a tuberculous coxitis due to loosening of a total hip endoprosthesis

A 45-year-old woman who suffered from juvenile tuberculous coxitis at the age of 4 is presented. Her hip joint replacement lasted for 18 years and then needed replacing. Intraoperatively removed caseous soft tissue and an opalescent secretion histologically resembled a tuberculous focus, and bacteriological culture grew a Mycobacterium tuberculosis strain. Four months after the replacement, the patient suffered from a tuberculosis-induced septic loosening of the newly replaced hip joint endoprosthesis. The tuberculosis relapse was probably due to aseptic loosening of the first hip joint endoprosthesis.     

An analysis of selected risk factors of aseptic loosening of hip endoprosthesis]

An analysis of selected risk factors of aseptic loosening of hip endoprosthesis has been attempted on the ground of retrospective evaluation of 57 hips in 54 patients (41 females, 13 males) who underwent revision of the hip replacement. Age of the patients at primary surgery ranged from 18 to 73 years (mean 55.6 years). Follow-up ranged from 8 to 212 months (mean 83 months). Originally, in 45 cases cemented hip replacement was done and in 12 cementless endoprosthesis was implanted. In 34 cases both components were replaced, in 14 cases acetabular component, in 9 cases stem only and in 1 case the endoprosthesis was removed. Clinical evaluation was done according to Merle-d'Aubignea criteria, radiologic assessment was done according to DeLee and Charnley classification and the one of Gruen. Within 10 years after primary surgery all cementless hips were revised (all Parhofer-M?nch type within 5 years). Among Weller cemented replacements both components were replaced in 18 cases, acetabulum in 8, the stem in 5 and 1 endoprosthesis was removed. McKee-Farrar implants were replaced completely in all but 2 cases. Most of revisions among cemented hip replacements took place 10 years after primary operation. Angular migration of the acetabular component was found in 40 cases; in 8 cases no migration was observed. Forty-three hips with loosened stem have been analyzed: to small size of the stem was found in 6 cases, varus deviation was found in 14 cases and valgus deviation in 6. Special attention has been paid to the technical errors that are essential for long-term result of hip replacement.     

Long-term results of endoprosthesis of the hip joint with Plus-Endoprosthetic prosthesis

An experience and results with using endoprosthesis of the hip joint with Plus-Endoprosthetic prosthesis in 937 (1018 operations) patients were analyzed. The period of follow-up observations was 12 years. Distinctive characteristics of the endoprosthesis are described. Specific behavior of this construction in patients with diseases and damages of the hip joint are shown. Results and complications of the endoprosthesis operations are analyzed. In whole, excellent and good results were obtained in 99.42% of cases, satisfactory - in 0.47%, unsatisfactory - in 0.11%.     

Stump lengthening after hip disarticulation using a modular endoprosthesis in 5 patients

To reduce the disability after hip disarticulation, we developed a special surgical procedure in patients having a proximal femoral tumor with a large tumor involving the sciatic nerve or neoplasms involving the tibia and femur. The hip was disarticulated, but we preserved a musculocutaneous flap. A modular endoprosthesis was then placed in the acetabulum or, in case of an extraarticular resection of the hip joint, it was placed in the iliac bone. A trevira tube was used for reconstruction of the joint capsule and fixation of soft tissues. We performed this procedure in 5 patients who had a good functional outcome.     

Endoprosthesis in patients with dysplastic coxarthrosis or in those who suffered Perthes' disease in childhood

Endoprosthesis of the hip joint was performed in 48 patients with coxarthrosis aged 40-50 years, which had occurred after the Perthes's disease. The non-cement fixing of the Ver Sys endoprosthesis was applied, osteotomy and bringing down of the greater trochanter were done in 33% of observations simultaneously or 3-6 months before doing the endoprosthesis.     

Follow-up analysis of total hip endoprosthesis after femoral neck fracture with and without previous operation]

Damage occurring after joint-preserving surgical treatment of femoral neck--mostly femoral head necrosis of pseudoarthrosis-necessitates endoprosthetic joint replacement. In the case of inferior bone quality and unfavorable fracture forms as well as after failed conservative therapy, surgical treatment consists of implanting a total hip endoprosthesis. Between 1971 and 1989, 120 patients received total hip replacement after suffering fractures of the femoral neck: 61 patients did not have previous surgery, 59 patients had had joint-preserving surgery. Statistical analysis of the results showed that the primary stabilizing operation to preserve the joint did not have a negative influence on the survival probability of the total hip replacement in comparison with primary implantation. If the joint-preserving primary intervention fails, total hip replacement is a good choice for secondary surgery. In the case of complications such as femoral head necrosis or pseudoarthrosis the indication for total hip replacement should therefore be made early on.     

Stump lengthening after hip disarticulation using a modular endoprosthesis in 5 patients.

To reduce the disability after hip disarticulation, we developed a special surgical procedure in patients having a proximal femoral tumor with a large tumor involving the sciatic nerve or neoplasms involving the tibia and femur. The hip was disarticulated, but we preserved a musculocutaneous flap. A modular endoprosthesis was then placed in the acetabulum or, in case of an extraarticular resection of the hip joint, it was placed in the iliac bone. A trevira tube was used for reconstruction of the joint capsule and fixation of soft tissues. We performed this procedure in 5 patients who had a good functional outcome.     

Stump lengthening after hip disarticulation using a modular endoprosthesis in 5 patients

To reduce the disability after hip disarticulation, we developed a special surgical procedure in patients having a proximal femoral tumor with a large tumor involving the sciatic nerve or neoplasms involving the tibia and femur. The hip was disarticulated, but we preserved a musculocutaneous flap. A modular endoprosthesis was then placed in the acetabulum or, in case of an extraarticular resection of the hip joint, it was placed in the iliac bone. A trevira tube was used for reconstruction of the joint capsule and fixation of soft tissues. We performed this procedure in 5 patients who had a good functional outcome.     

Kinetic and kinematic gait analysis before and after total knee endoprosthesis implantation

OBJECTIVE: The aim of the present paper was to make an objective assessment of the surgical outcome after primary knee endoprosthesis implantation by means of gait analysis. METHOD: Kinetic and kinematic parameters of gait pattern were recorded using multi-component measuring platforms integrated into a treadmill and an optoelectric measuring system. 20 patients were investigated preoperatively and on average 14 and 28 weeks postoperatively. RESULTS: Preoperatively, on the affected side, the leg was used for a shorter time, but with much higher maximum forces. Mobility was reduced in the affected joint, in the adjacent hip joint, and in the contralateral joints when walking. After endoprosthesis implantation, the gait pattern approximated that of the reference group. The gait symmetry increased, and the time and force-related loading of the operated leg and the extent of mobility of the contralateral knee and both hips increased up to 28 weeks postoperatively. The clinical score according to Aichroth et al. showed a correlation with the measured values of the gait analysis at all times (p < 0.05). CONCLUSION: Mono-articular degenerative changes of the knee have a negative effect on the function of adjacent and contralateral joints. Endoprosthesis implantation then leads to a normalisation of pathological motion patterns, both in the operated and in the adjacent and contralateral joints. However, normal values were not yet achieved 28 weeks postoperatively, which demonstrates the possibility for further functional improvement depending on the continuity of rehabilitation.     

Postinfectious coxarthrosis and its surgical treatment

Results of the observation of 27 patients with postinfection coxarthrosis have shown expedience of using alloplasty of the hip joint with a demineralized osteocartilaginous transplants instead of operations of endoprosthesis in young patients. An original technique of alloplasty of the hip joint is proposed.     

Athletic activity after total joint arthroplasty

Demand for total joint arthroplasty is projected to increase in the first three decades of the twenty-first century. With increasing frequency, patients who have a hip or knee replacement expect to, and choose to, participate in athletics following rehabilitation. In general, patients who have had a hip or knee replacement decrease their participation in, and intensity of, athletic activity following the total joint arthroplasty. The orthopaedic literature on athletic activity after total joint arthroplasty is limited to small retrospective studies with short-term follow-up. Expert opinion regarding appropriate athletic activity after total joint arthroplasty is available from the Hip Society and the Knee Society. When patients who have undergone joint replacements choose to participate in athletic activity, orthopaedic surgeons should provide information with which to evaluate the risk of sports activity and recommend appropriate athletic activity.     

Revisionseingriffe nach Azetabulumfraktur

Complications and protracted courses are not uncommon following acetabular fractures. The aim of osteosynthesis should always be anatomical reconstruction with a step-free restoration of joint areas. If steps remain or osteosynthesis is insufficient, early revision is recommended to achieve optimal results. In the case of posttraumatic arthrosis, endoprosthesis can often not be avoided. A stable cup position is important in younger patients, since a change of endoprosthetic components is to be expected. For older patients primary hip prosthesis can be considered in the case of single-column fractures. In the case of two-column fractures, consolidation of the cup fundament should first be awaited; otherwise, anchorage of the endoprosthetic components cannot be achieved. Endoprosthesis after previous osteosynthesis is comparable with results seen in endoprosthetic revision surgery. Post-traumatic endoprosthesis has worse results than primary endoprosthesis in cases of osteoarthritis. Nevertheless, patients benefit from the better functionality compared to a Girdlestone situation or even a hip joint arthrodesis. The management of post-traumatic coxarthrosis is a challenge even in experienced hands and requires individual planning.     

The clinical assessment of immunological tests in hip replacement

The reaction of organism to hip replacement was studied in 75 patients. The reaction developed in response to operative intervention either immediately after the operation (within 1-3 months) or to the beginning of the active functioning of the artificial joint (from the 6th month after operation). The development of complications after implantation of the endoprosthesis was followed by certain shifts of immunological indices. Prognostic criteria of the development of the implant instability before operation were a reduced level of immunoglobulin G and higher concentration of immunoglobulin E, in the long term period they are an increased level of IL-1 and of the content of cytoplasm cationic proteins of neutrophils.