Hip and Knee Prosthesis

HIP PAINS IN ADULTS

Hip pain is common as a result of many ailments. The location of the pain in the hip gives information about the cause of the pain. Pain in the hip joint usually causes pain that spreads to the inner part of the leg and the groin. Pain in the outer edge and back of the hip is usually caused by the muscles, tendons, ligaments and soft tissues surrounding the hip. In some cases, patients may feel pain in their hips as a result of discomfort in the knee or lower back. Pain around the hips; It can be caused by injuries of the soft tissues around the hip, fractures and dislocations of the hip, compression of the nerves around the hip, arthrosis of the hip, avascular necrosis (death of the bone as a result of decreased blood supply at the head of the thigh bone), osteomyelitis (bone infection), osteoporosis and cancer.

There are strong ligaments and strong muscles around the hip. After the exercises, reverse movements, excessive walking or running, after a trauma, these muscles can be stretched, small tears may occur, tears in the ligaments or germ-free inflammations may occur in the tendons that connect the muscles to the bone. These pains are usually felt near the hip. Some accidents, especially falls from a height, cause fractures in the thighbone and dislocations in the hip joint. Spontaneous hip fractures may occur in older people as a result of osteoporosis. As a result, pain in the hip may occur. Pain occurs in the hip as a result of compression of the nerves around the hip. These pains usually spread to the leg. Hip arthrosis pain is usually felt on the inside of the hip. This pain increases with walking. Hip arthrosis can occur as a result of rheumatic disorders, as a result of fractures in the hip, as a result of deformities in the shape of the hip joint, as a result of untreated congenital hip dislocation, and mostly due to events of unknown cause, which we call primary. Among the things to be done to relieve the pain of hip arthrosis at a young age are weight loss, strengthening the muscles around the hips and performing surgeries to reduce pain. As a treatment in advancing ages, hip replacement saves the patient from their troubles.

It is the death of the bone as a result of disruption of the blood supply to the femoral (thigh bone) head. This is called avascular necrosis of the femoral head in medicine. In some patients, the cause is not fully understood. Cortisone use, alcohol use can cause this ailment. Hyperbaric oxygen therapy can be used as a treatment to avoid putting a load on the hip for a long time. In advanced cases, hip resuscitation surgeries can be performed. If the damage to the femoral head is excessive, the hip goes to arthrosis (calcification) over time and hip replacement becomes inevitable as a treatment.

It is the death of the bone as a result of disruption of the blood supply to the femoral (thigh bone) head. This is called avascular necrosis of the femoral head in medicine. In some patients, the cause is not fully understood. Cortisone use, alcohol use can cause this ailment. Hyperbaric oxygen therapy can be used as a treatment to avoid putting a load on the hip for a long time. In advanced cases, hip resuscitation surgeries can be performed. If the damage to the femoral head is excessive, the hip goes to arthrosis (calcification) over time and hip replacement becomes inevitable as a treatment.

In mild hip pain, the patient should first rest. As rest, it should reduce the load on the painful hip and should not lie on the painful hip. It is useful to use simple painkillers to relieve mild hip pain. Ice can be applied to the painful hip. In some pains, heat can be applied to relax the muscles, and the hip can be relieved with stretching exercises.

In which cases should a doctor be consulted? In some cases, a doctor should be consulted immediately for hip pain. If there is a hip deformity, if there is difficulty in moving the leg or hip, if the painful hip cannot be pressed on, if intense pain occurs, if sudden swelling and redness develops, if there is pain in the hip with fever, chills, the patient should definitely consult an orthopedic and traumatology doctor. Hip pain makes it difficult for the person to walk, and in some cases, it also affects sitting. Hip pain has many causes. For persistent pain in your hip that does not go away, you should consult a specialist doctor.

WHAT SHOULD PATIENTS FOLLOW HIP PROSTHESIS?

When arthrosis (calcification) develops in the hip joint, pain occurs in the hip joint, especially during walking. These pains are usually felt in the groin area. As a result of the progression of calcification, the patient starts to limp while walking and the severity of the pain gradually increases. There is a decrease in hip movements and difficulty in squatting, difficulties in wearing socks and shoes begin. Hip replacement is required for the treatment of patients with such complaints. There are some things that the patient who has a hip replacement should pay attention to after the surgery.

After hip replacement surgery, the patient is taken to the room. In the early period of the surgery, the hip joint may become dislodged in a reverse movement when the patient is not unconscious due to the effect of anesthesia. For this reason, the patient should be taken to the bed carefully and the patient lies on his back in the bed and a pillow is placed between the legs. If a drain (the system used to drain the blood from the wound area) is inserted after the surgery, it is followed up by the nurse at regular intervals, and if the reservoir is full, it is emptied. Some specialists may not use drains in these surgeries.

One day after the operation, the patient is taught how to sit in bed and how to get up and walk in bed. To avoid dislocation of the hip joint, the patient's leg should not turn in or out excessively, and the legs should be spread apart. The hip should not be bent more than 90 degrees while sitting. For this reason, the patient should not sit on low places such as sofa beds and stools. If the toilet in the house is low, a toilet riser should be used. During this period, the patient walks with the help of a walker. It can be loaded on the leg as much as the pain in the hip allows. In the morning visit, the doctor teaches the patient the exercises that should be done to strengthen the muscles around the hips.

On the first day, the pain of the patients will be greatly reduced. The patient is dressed and can be discharged home one day after the operation, depending on the pain condition. The patient who goes home should constantly do the exercises given to him. When he has pain, he should use painkillers prescribed by his doctor. The patient can see his own needs at home. He can use a walker or a cane (cane) as an assistive device for walking. They should continue to use a walker or cane for as long as their doctor recommends.

The patient gets dressing every other day and comes to the control 10 days later to have the stitches removed. The patient can take a bath 1 day after the stitches are removed. After this stage, the patient can walk using a single cane according to the advice of his doctor. In the early period of the operation, the patient cannot squat down and put on the socks himself. In general, the patient becomes able to wear his socks himself in the 4th month.

Although it is unlikely, the hip prosthesis may be dislodged in the early period with a reverse movement. In such a case, the patient should contact his doctor. Usually, the patient's hip is placed in place under anesthesia. If the hip prosthesis comes off repeatedly, the prosthesis may need to be replaced.

Another important issue is the possibility of blood clots in the leg veins of patients who have had hip replacement. Although this event is rare, precautions should be taken in every patient. It is recommended that patients wear pressure antiembolic (anti-clotting) stockings (compression stockings) up to the thigh. To prevent clots, injection-style medications or pills recommended by the doctor should be taken every day for 35 days. Swelling or redness in the calf should be reported to the doctor. Patients who have undergone prosthetic surgery should tell the dentist that they have a prosthesis in their hips and take antibiotics before the procedure.

Calcification of the knee (gonarthrosis)

The knee joint is the largest joint in our body and carries all our weight. As age progresses, wear and tear can occur in the knee joint. As a result of these wears, arthrosis (what we call knee calcification among the people) develops in the knee joint. Knee osteoarthritis is detected in 3 out of 1000 people in the community every year. In this article, we will first talk about the causes of knee osteoarthritis, what we can do to prevent it, and the methods applied in medicine to delay its progression, and then we will talk about when knee replacement surgery is required.

Knee calcification is rare in young people, as age progresses, wear on the knee increases and the knee goes into calcification. It occurs more frequently in women than in men. If there is a person in your family who has arthritis in their knees, you may also develop this ailment. As a result of your knee fracture, meniscus tear, ligament tears, there is a risk that your knee will become calcified over time. The risk of developing knee calcification is higher in people who work by constantly bending their knees on the ground, people with weak leg muscles and people who are overweight.

If there are risk factors that we have just mentioned, we can take some precautions to prevent calcification in the knee. First of all, we need to strengthen the muscles around the knee. If the muscles around the knee are strong, the muscles will carry the load on the knee joint and the amount of wear on the knee will decrease. Each extra kilogram of string in our body creates a load of 3 kilograms. If you have an excess of 10 kilograms, there is an extra load of 30 kilograms on your knee. In order to reduce the load on the knee, you need to get rid of your excess weight. If you need to bend your knee all the time due to your job or if you need to put your knee on the ground, it is useful to use a knee pad.

It is useful to consult an orthopedics and traumatology specialist when recurring pains in your knee begin. If there are signs of calcification in your knee film taken after the examination, your doctor will recommend you treatment according to the level of the disease. First of all, exercises to strengthen the muscles around the knee are started. Half an hour walks on the flat road during the day will be beneficial. According to the level of your pain, your pain will decrease by using painkillers that your doctor will recommend. In addition, losing weight will significantly reduce your pain and delay the progression of your disease. In some cases, an intra-knee corticosteroid (cortisone) injection will significantly reduce pain.

To talk about the operations to be performed in knee calcification, if the knee calcification is not too advanced and there is a curvature in the leg, the curvature of the leg is corrected and a high tibia osteotomy, which is an operation to correct the load distribution on the knee, is performed. The aim of this surgery is to delay the developing calcification in the knee and it is predicted that these patients will go to knee replacement surgery after 10 years. If there is calcification in only one part of the knee, a half knee prosthesis can be used in such patients. If our patients cannot do the work they need to do during the day, if they need rest when walking short distances, if the pain wakes them up at night, if the joint space is closed in the X-rays, then knee prosthesis is required. With properly made knee prostheses, the patient can walk one day after the operation and can return to his normal life after the wounds heal.

WHAT SHOULD PATIENTS UNDERSTAND KNEE PROSTHESIS?

The walking distance of patients with gonarthrosis (calcification of the knee joint) decreases during the day. When he wants to go to his nearest neighbor, he will need to sit and rest a few times on the way due to pain. These pains will start to happen when you sit at home over time. If these pains are starting to make you sleepless, it means it's time to have knee replacement surgery. The orthopedic and traumatology specialist consulted for these pains will recommend knee replacement surgery after evaluating the examination and x-rays taken. In this article, we will talk about what patients should pay attention to after knee replacement.

Knee replacement surgery was performed and the patient was taken to the bed after the operation. In this period, it will be beneficial to put ice around the knee joint to prevent excessive bleeding in the patient's knee. If a drain (the system used to drain the blood from the wound area) is inserted after the surgery, it is followed up by the nurse at regular intervals, and if the reservoir is full, it is emptied. Some specialists may not use drains in these surgeries. If the patient keeps the knee constantly bent due to pain, then he will have difficulty in extending the knee straight. For this reason, it is important for the patient to keep his leg straight in the early postoperative period. If necessary, the knee joint can be straightened by placing a few pillows under the patient's feet.

In the morning visit one day after the operation, the patient is shown by the doctor how to walk with the help of a walker. In knee prostheses performed without any problems, the patient can walk with full load on his leg. The patient can then go to the bathroom with the help of a walker. If these patients do not have any additional problems, they should not use or request a urinary catheter or diaper in any way. Exercises to strengthen the muscles around the knee are started by the doctor to the patient who is taught to walk. A second exercise is the exercises required to bend the knee joint. The patient should do exercises that will enable bending the knee as well as strengthening the muscles.

On the first day, the pain of the patients will be greatly reduced. The patient is dressed and can be discharged home one day after the operation, depending on the pain condition. The patient who goes home should constantly do the exercises given to him. When he has pain, he should use painkillers prescribed by his doctor. The patient can see his own needs at home. He can use a walker or a cane (cane) as an assistive device for walking. Some patients may discontinue these assistive devices in the early period as their pain subsides. Patients with pain should continue to use a walker or cane for as long as their doctor recommends.

The patient, who is discharged home, needs to be dressed every other day. It would be more appropriate for a healthcare worker to do the dressing. The point to be considered while dressing is that the gauze pads should be sterile (free from microorganisms). Adhering the bands on the dressing while the knees are bent will not restrict the patient from bending the knee. 15 days after the operation, the patient should go to the doctor who performed the operation for a check-up. The dressing is checked by the doctor and the stitches are removed. The patient's gait and how much he bends his knee are checked. It is tested whether the patient needs an assistive device to walk. Most of the patients are able to sustain their lives without the need for an assistive device at the end of 45 days. Patients with weak muscles around the knee, incompatible with exercise and having difficulty in bending or opening the knee are referred to physical therapy and rehabilitation.

Another important issue is the possibility of blood clots forming in the leg veins of patients who have undergone knee replacement. Although this event is rare, precautions should be taken in every patient. It is recommended that patients wear pressure anti-embolism (anti-clotting) stockings up to the level below the knee. To prevent clots, injection-style medications or pills recommended by the doctor should be taken every day for 15 days. Swelling or redness in the calf should be reported to the doctor.

The purpose of knee prosthesis is to enable the patient to walk without pain. As an orthopedic and traumatology specialist, the most important advice I give to patients who have had knee replacements is to walk as much as they can.

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Oscar Ville Ofisleri
No:26/1 Tekirdağ Merkez

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