From a mild annoyance to intense pain,
it is also disabling. This is hip
osteoarthritis, the leading cause of hip
implants worldwide. This condition
usually occurs especially among people
of middle and old age, so that
interventions to introduce hip have
increased in the last decade at a
spectacular rate.
A traditional surgery joins the
minimally invasive. Although still
little used in comparison with
traditional systems, providing greater
patient comfort and reduces the cost of
hospitalization to specify a shorter
post.
In our review sample was taken as all patients
who underwent hip arthroplasty at the
Hospital Marcelino Vélez
Santana (HMVS) in the period January
2007 to January 2008, and we take
variables as age, sex and why were
performed.
Almost 90% who is a hip
replacement are people who have exceeded
55 years. Over 80% of cases, the disease
caused by the need to use a prosthetic
hip is osteoarthritis (wear and tear
condition that causes the articular
cartilage and causes pain and
stiffness), although the joint may also
be damaged by other rheumatic diseases
such as rheumatoid arthritis. In
principle seeks to alleviate the
symptoms of the disease with
conservative treatments, which aim to
reduce pain and improve joint mobility
of the injured only when relief is not
achieved, it involves placement of a
prosthetic hip, one of the largest
Advances in orthopedic surgery of the
twentieth century.
This artificial joint
design and use should be generalized to
Sir John Charnley, a British orthopedic
surgeon who developed alongside a team
of engineers, technical and prosthetic
materials used in hip prostheses.
Articulation is a structure of the body where
bones come together. In the case of the
hip are the femur, the upper end is a
sphere with a cavity in the pelvis are
called joints. The ends of the bones
forming the joint are covered with
articular cartilage that cushions the
forces acting on bone and allows the
movement of the joint. In addition, the
joint is surrounded by a capsule covered
by the synovial membrane that produces a
lubricant (synovial fluid) that helps
reduce wear. When you suffer from
osteoarthritis synovial membrane
produces chemicals that destroy the
articular cartilage and cause pain and
stiffness, so the patient avoids the
movement of the joint.
If the destruction is gravely affected joint can return
to play only part of their daily
activities at the resort if your hip
replacement by an artificial joint.
Depending on the age and condition of
each person using one or another type of
prosthesis. The most widespread is that
the prosthesis is fixed to the bone with
acrylic cement used in patients older
than 70 years. In this case, the bone
has poorer quality and not the
prosthesis can not adhere properly. For
younger patients using the titanium
prostheses, which allow bone to grow and
adhere strongly to the prosthesis, the
implant is more durable and safer. When
worn, it can change only the worn
components and not complete the
prosthesis. Although not very frequent,
are also mixed or hybrid prosthesis, in
which one part is fixed to the bone
without cement and other cement.
Elimination of
pain
There is no doubt about the main benefit of the hip.
For the patient it means something as
valuable as the disappearance of pain.
However, it does not evaporate in one
day after the operation may be
discomfort for weeks or even months. The
case is both within the surgery and in
the muscles surrounding the joint are
weakened by the long time they have
remained inactive. The conventional,
usually done under spinal anesthesia
(asleep the body from the waist down)
lasts between 90 and 120 minutes and
allows the patient to move in a few days
aided by walking sticks.
After receiving the discharge, the patient should
exercise at least three times a week for
a period of not less than three months,
which improves the mobility of the joint
and allows almost normal life, although
not recommended for contact sports.
Although all patients notice improvement
after the implantation of the
prosthesis, not in all cases the
recovery is the same as it depends on
what that was injured before his
articulation of the intervention.
Currently there is also a minimally invasive surgery,
which has been used in the Hospital of
the George Washington University. This
procedure, which lasts about 120
minutes, is more comfortable for the
patient and only requires two small
incisions of no more than 5 centimeters.
The benefits are perceived, especially
after the operation. While traditional
hip surgeries require a hospital stay of
three to four days, most patients with
minimally invasive surgery can go home
the next day.
Risks associated
Any intervention carries risk and replace the hip by an
artificial joint was not going to be
less. In this case, the major potential
complication is infection that can occur
in the area of the wound, not more
serious and is usually treated with
antibiotics. However, there is a case
that presents major problems: the
infection develops around the prosthesis
when it is necessary to withdraw the
artificial joint.
In addition to the risks in the world of
prosthetics, there is another factor to
be taken into account, the lifetime of
artificial joints, which is limited. In
90% of cases, the duration of total hip
prosthesis over fifteen years, passed
this time, due to loosening of the
prosthesis, it is necessary to change
it. Hence it is recommended that
periodic inspections per month, per year
for 5 years and 10 years of having the
prosthesis implanted.
Surgical
technique
A hip replacement by an artificial joint is a
surgery that is usually performed by
administering spinal anesthesia to the
patient. The surgical procedure involves
an incision of about 15 centimeters on
the side of the hip joint until the
damaged is removed and replaced with a
prosthesis made of artificial materials.
In place of the upper end of the femur
(which is like a sphere) is placed a
metal sphere attached to a rod that is
inserted into the bone. Here are
implanted in a plastic dome of the
spherical cavity of the pelvis damaged.
In minimally invasive surgery developed recently,
two incisions of only 5 cm. With
radiographic guidance, the surgeons
insert small tools to remove the board
and replace it with a metal and plastic
implant. Moreover, instead of crossing
ligaments, muscles and tendons, as in
traditional surgery, around the same.
The materials used in these implants are designed
to allow a mobility similar to the prior
of the joint. This will use various
metals such as stainless steel, alloys
of cobalt, chromium and titanium and
plastic, usually polyethylene, which is
very durable and resistant to wear
resulting friction. In the traditional
prosthesis cement is often used to set
the artificial bone component, although
some cementless prosthesis, which fit
directly into the bone and are
frequently used in younger patients.
RESULTS
In the period January 2008 to January 2009 in HMVS were
a total of 34 hip arthroplasty, 15 of
these were partial and 19 total. 69%
were performed on women ages 50 to 74
years with an average of 66 years and
31% of men aged 44 to 70 years with an
average of 55 years. The most frequent
cause was arthritis of the hip with a
73%, followed by post traumatic with 23%
and finally fractures consolidated with
a poor 4%.
Based on the results of our review, we
conclude that our statistics do not
differ from others in other countries
where post-menopausal women are most
affected by osteoarthritis secondary to
rheumatoid arthritis and so are the most
underwent hip arthroplasty, however, we
can note that men are regularly operated
on at younger ages because the men are
more prone to high-energy trauma that
affects the joints and damage to the hip
here.
Every day, more hip arthroplasty performed because the
aging population is more active and do
more sports, that's why we've kept pace
with technological advances to be able
to provide a better quality of life.
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