Summary of Common Problems after Top Hip Arthroplasty (THA)

source:By Jason ChengNumber of Readings: secondRelease time:2019-08-10 09:45

After hip arthroplasty, through rehabilitation training, patients can basically recover to the normal level of activity, that is, all kinds of activities in life can be done. However, to achieve such an effect, there are certain prerequisites:

Firstly, the diseases leading to hip replacement are not special diseases. If the patient needs hip replacement because of rheumatoid arthritis, ankylosing spondylitis and other diseases, then even after joint replacement, the patient may have multiple joint deformities because of the existence or continued development of these diseases before surgery, and some patients may even have spinal deformities, such as anterior arch, kyphosis and kyphosis. Side bending, etc. These deformities of the spine and joints will affect the use of artificial hip joints to a certain extent, thus preventing the patients from recovering to the normal level of human activity.

Secondly, if it is caused by common diseases such as femoral head necrosis and femoral neck fracture, these patients should ensure that no hip dislocation occurs within six weeks after hip replacement. Once hip dislocation occurs, timely reduction and movement restriction are needed. If repeated dislocation occurs, secondary revision should be considered. Even after rehabilitation training, it will take a longer time to recover to the normal level of activity.

For the above two preconditions, the first point is that because of the nature of the disease, patients cannot change after surgery, so there is nothing to do. But for the second point, patients are able to do it. In order to prevent dislocation of artificial hip joint, patients can do sitting and standing within six weeks after operation, but try not to sit on low stools or low sofas. Only after six weeks can they sit. In addition, do not cross your legs or cross your legs for 6 weeks. If the affected side is on the top of each turn, you need a pillow between your legs. For squatting, it is generally recommended to do it three months or six months after the operation, especially within six weeks after the operation.

In addition, the time of walking after surgery also has certain requirements: within six weeks after surgery, patients can walk slowly with walkers three times a day early, middle and late, but only need to sit down and rest about 15-20 minutes each time; after six weeks after surgery, the time can be extended to about half an hour each time. If the patient walks too long each time, it will increase the pressure of artificial hip joint in a short time. At the same time, it is easy to suffer from limb edema, which can also lead to muscle soreness due to long exercise time, affecting the recovery process after operation.

Postoperative rehabilitation training: six weeks is the dividing line.

Don't rush for rehabilitation training after hip arthroplasty. Because the hip joint is a spherical fossa joint, it has a stable process when the artificial hip joint is installed. In order to prevent dislocation of artificial hip joint, in principle, do not do too much exercise within six weeks after operation. Real rehabilitation exercise should begin after six weeks after operation.

Is it possible to lie still within six weeks after surgery? Of course not. The rehabilitation needs of patients within six weeks after operation include:

How to prevent thrombosis within six weeks after operation?

Use of plantar vein pump (usually in hospital): The plantar vein pump can be used on the second day after operation, and it can effectively prevent thrombosis if it persists for one week. Because although patients can go down quickly after operation, they still need to restrict their activities. When patients do not go down, plantar venous pump can help patients do contractile activities, squeeze veins, increase blood reflux, and prevent thrombosis. It can be said that this is a passive contraction training.

Crus muscle contraction training, promote blood circulation. Specific training methods are as follows: the affected limbs are stretched out on the bed as far as possible, the toes are extended to the head and back as far as possible, the muscles on the legs are stretched as tight as possible, holding for 5 to 10 seconds, then relax, and continue to practice, 20 groups at a time, 2 to 3 groups every day. This is an active contraction training to prevent thrombosis.

Axis flexion and extension training mainly includes active bed-side gravity natural droop and passive CPM machine-aided training.

How to Rehabilitate after Six Weeks of Operation

Six weeks after the operation, the real rehabilitation training began. Patients need abductor training, which is the most important training after hip replacement. The abductors of hip joint mainly include tensor fasciae latae, gluteus medius and gluteus minor. These muscles can not only abduct the hip joints, but also play a stable role in weight-bearing exercise, especially in walking, which plays an important role in stabilizing the pelvis and maintaining body balance.

Exercise abductors, mainly by side leg lifting exercises, lateral lying in bed or standing position can be. Specific methods are as follows: patients lie on the side; the affected limb is on the upper side. First, the affected limb is abducted, that is, raising the leg, lifting the ankle and toe upward, 45 degrees with the other leg. On this basis, the affected limb is extended backward for 10 seconds, then relax for 10 seconds, and then continue training. 10-20 times a day and 10-20 times in the afternoon. After 6 weeks of general training, the pain will be relieved obviously, and walking limp can also be improved. At the beginning of the training, if the abductor muscle strength is very poor, you can only stand up and raise your legs laterally. After a period of training, the muscle strength will be strengthened, and then gradually turn to the lateral decubitus position.

It is worth noting that patients are often required to do quadriceps exercise after knee arthroplasty, but this kind of training is not recommended after hip arthroplasty, because it is easy to cause great pressure on the hip joint. Straightening and lifting the legs requires the strength of the thighs, so lifting the legs is equivalent to a lever to pry, using the weight of the whole leg to pry the newly replaced hip joint, which is very dangerous. Therefore, it is not recommended to do straight leg lifting after hip arthroplasty, and to lie flat on the bed is only to do leg lifting exercises.


Two kinds of pain in THA rehabilitation training are normal phenomena

Rehabilitation training after hip arthroplasty can help patients recover their normal level of activity as soon as possible. However, there will inevitably be pain in rehabilitation training, so do you need to stop training if there is pain?

In fact, no matter what kind of training patients do at home after surgery, when the training intensity is slightly higher, it will basically lead to leg soreness or wound pain. At this time, the patient must stop exercising decisively and observe for 2 to 3 days. If the pain disappears after the training stops, then the training can be resumed. Just keep the training intensity consistent with the previous one. Don't alleviate the training intensity because of pain. However, it is worth noting that if the pain does not disappear after training, but continues, then timely medical treatment is needed.

In addition, after hip replacement, many patients have a similar experience: they walk and the bone hurts. In fact, within three months after surgery, this phenomenon is very normal. Because hip replacement patients don't begin muscle training until six weeks after surgery, they often don't have strong muscles. The loss of muscle protection in joints is like the loss of lubricant. Two hard objects can bump into each other, causing a feeling of collision and sometimes pain. Therefore, after the replacement of the artificial hip, patients often have a "walk, and then the bone pain" feeling.

However, if the pain still persists for more than three months, you need to go to the hospital to check for blood sedimentation, c-reactive protein and other items to see if there are any other problems.


What kind of motion is moderate after hip replacement?

After artificial hip replacement, some patients do not pay attention to the protection of the new joint, that can be carefree, that has replaced the joint; Other patients pay too much attention to the new joint and do everything carefully. So what kind of exercise and diet is "moderate" after hip replacement?

1. Squatting, wearing shoes and socks are not recommended within six weeks after operation. After six weeks of operation, wearing shoes, socks, walking, jogging and swimming can be carried out. If some patients are not reassured that six weeks after surgery is too early, it can also be postponed to three months later.

2. After total hip arthroplasty, it is not entirely impossible to cross legs. It is only three months after the operation that these behaviors can be performed after the patient has recovered well. If cross-legs and other movements are performed within six weeks after operation, it is likely to lead to dislocation of the hip joint, which is very dangerous.

3. After surgery, patients should not sit for a long time, because sitting for a long time is a test for hip joint, lumbar spine, etc. Generally, the term "long" means more than 30 to 40 minutes. That is to say, patients are recommended to sit for 30 to 40 minutes, then stand and walk for a period of time;

4. After the operation, the patient should pay attention to "good up and bad down" when going up and down the stairs, that is, when going up the stairs, the healthy leg should go up first, while going down the stairs, the leg on the surgical side should go down first. In addition, within three months after the operation, the patient should try to hold the handrail up and down the stairs. Because on the one hand, the joint may not be very stable after the hip replacement; On the other hand, patients may fall after surgery because of muscle weakness. But three months after the operation, if the patient has recovered better by doing side leg lifts, there is no need to be so careful;

5. If femoral head necrosis is caused by alcohol consumption, and hip replacement is needed, such patients may still recommend abstinence from alcohol or reduce alcohol consumption even if new joints are replaced. Because continued drinking after surgery may lead to femoral head necrosis on the opposite side (good side), but also may cause damage to the liver and kidney.

6. There are not too many dietary considerations after hip replacement. There is no need to avoid food due to operation.


How do you sleep after hip replacement?

For patients who have only one hip replacement, it is often doubtful whether they can sleep sideways after the replacement. Will side sleeping "crush" the new hip joint?

In fact, patients can sleep without scruple 1 to 2 days after surgery, not necessarily until six weeks or three months after surgery. Because the human body has natural "protective measures", such as the muscles around the joint, synovial fluid and so on, they always protect the safety of the joint. In addition, hip arthroplasty should be performed with very strong fixation. If the hip joint is not fixed properly, it will go wrong even if you do not press the joint. On the other hand, for the fixed hip joint, random pressure is rarely a problem. Artificial joints need to be used for 20 to 30 years, or even longer. 

However, it is important to note that within six weeks after hip replacement, if the patient sleeps on his side, a pillow must be placed between his legs. While the affected side is below, instead of adding a pillow, you can sleep with no scruples.

Well, what's the use of a pillow? As an aside, when you do an operation to correct a dislocation of the hip, the surgeon will put the patient in a side position, with the affected side up, the adducted side will put the legs together, and then remove the hip. See here, everyone will understand, this position is the risk of dislocation of the hip, although the risk is very small, the vast majority of patients with sleep so didn't appear what problem, after one thousand, but in order to prevent or advice within six weeks after surgery, the side to sleep on it, in between my legs and a pillow, don't let a leg and together, the hip joint will be more stable. By the end of the six weeks, the capsule is firm enough that it doesn't need these auxiliary protections.


How to insert insoles after hip replacement?

Unlike knee replacements, hip replacements involve the length of both legs, which can be longer or shorter after surgery. If the affected leg is longer after surgery, insoles should be placed on the healthy side and vice versa. Generally, more than 90% of patients, do not need insoles after surgery. Patients with bilateral limb length differences within 1cm after surgery rarely feel uncomfortable and do not need insoles. Only in some special cases, if the difference of length caused by surgery is more than 1cm, the insole should be used. Do so, it is to prevent because limbs do not differ long and affect lumbar vertebra, bring about spinal column side to bend, lumbar vertebra to degenerate then change, appear the symptom such as bone joint aches, lumbar aches, leg hemp. It is often difficult to repair lumbar spine problems caused by unequal limb length.

As for how high the insoles need to be, the general principle is how much the insoles are different. The measurement method is as follows: when the patients'legs are unequal in length, they take off their shoes and stand on the floor, put paper on the sole of their feet which feels short, and then continuously increase the thickness of the paper until they feel that the feet on the ground are the same, the thickness of the paper is basically the thickness of the insole.

Generally speaking, the height of insoles needed by patients is 1-3 cm. However, it is worth noting that if the patient's legs are more than 3 centimeters apart, the insole needs to be gradual, not 3 centimeters at a time. Because of the long-term difference in the length of the two legs, the lumbar spine is often affected. If the pad is high, the patient will feel that the short side of the leg becomes longer and the waist can not stand it. At this time, patients need to start with a 1 cm insole, after 4 to 6 weeks of adaptation, then increase to 2 cm, and finally gradually transition to the height of the need to pad.

As for the length of insoles, generally speaking, the longer the difference between the length of the two legs is, the longer the insoles will last. That is to say, if the length of the two legs is within 1-2 centimeters, the human body can generally accept and adapt to such a gap if the length of the two legs is within 1-2 centimeters; if the length of the two legs is 2-4 centimeters different, the insole may take a long time, 5 years or even longer, because in a short time, it is difficult for the human body to adapt to such a gap. Only when the waist slowly compensates, can gradually adapt; if the length of the two legs differs by more than 5 centimeters, it may need longer insoles.


Wound pain after THA should be treated after finding the cause.

After total hip arthroplasty, many patients reported that although the operation was successful, the wound was always painful. So, is this pain caused by surgery? What should we do?

In fact, a larger incision is needed for hip arthroplasty. First, the "bad bone" is sawed off, and then a new joint is installed. It is impossible for such a large operation to have no pain at all, but the pain should be treated differently according to the situation.

If the wound is painful within six weeks after surgery, the patient does not need to be overstressed. Because this kind of pain is the tissue damage that the operation causes, the inflammation reaction that causes, need to use only a few nonsteroidal kinds to reduce inflammation analgesic can, be like Fenbid, VoltarenGel to wait. For patients with gastric disease, consider drugs such as Celebrex and Meloxicam, which have little gastric stimulation, and indomethacin suppositories, which have little gastrointestinal stimulation. In addition, also can use a few medicaments that invigorate blood to dissolve silt appropriately. In summary, most of the pain within six weeks is sterile inflammatory pain, which can be resolved with medication. But if the patient thinks it's just a small problem and can handle it on his own, without the need for medication, then this untreated inflammation could further damage the patient's joints, with dire consequences.

Six weeks after hip replacement, both the wound and the capsule should heal and function well. If the patient still feels pain from the wound, the cause should be actively sought. In general, there are several reasons for continued pain more than six weeks after surgery:

1. Pain caused by infection

If the patient still suffers repeated pain more than six weeks or three months after operation, especially obvious intermittent pain and night pain, infection should be excluded first. At this time, we should actively seek medical treatment, review the two indicators of erythrocyte sedimentation rate and C-reactive protein, and ask the chief knife doctor for diagnosis and treatment.

2. Pain caused by muscle training

Six weeks after surgery, patients need muscle strength training. If the training is not good and the patient walks a little longer, he will feel hip soreness or pain near the lateral hip. The pain can be alleviated by abductor exercises.

3. Pain caused by other causes

Sudden pain or ankylosis occurred more than six weeks after the operation (i.e. the joint was suddenly stuck in motion, unable to stretch and flex, usually with sudden pain). It is necessary to consider whether there is hip dislocation or fracture caused by trauma. Active medical treatment is needed at this time.


How to deal with swelling after hip replacement?

After hip arthroplasty, many patients will have lower limb swelling for a long time. The reason for swelling is that in the process of hip replacement, doctors need to relax the surrounding tissues and muscles of the hip so that muscle relaxation is convenient for surgery, which will inevitably damage some small blood vessels which are not very important. When the blood vessels are affected, the blood circulation becomes worse and the venous reflux is not smooth, which will lead to lower limb swelling. Especially the hip joint is in a more important position, the blood flow of lower limbs must pass through the hip joint, so it is easier to appear lower limb swelling after surgery.

Generally, after rehabilitation training, there will be obvious lower limb swelling in the afternoon and evening, and after a night of lying down rest, the swelling will disappear. Six weeks or three months after the operation, if there is still lower limb swelling, especially compared with the other leg, the swelling of the affected leg is more obvious, it is recommended that patients go to the hospital to do a double lower limb venous color Doppler ultrasound, excluding the possibility of lower limb venous thrombosis. We should know that the typical symptom of venous thrombosis in lower limbs is swelling of limbs. If not treated in time, it may lead to pulmonary embolism because of the fall off of thrombus. Therefore, if lower extremity venous thrombosis occurs at this time, the treatment of thrombosis should be the main method.

If color Doppler ultrasound is done, it is determined that it is not lower extremity venous thrombosis, in order to eliminate swelling, patients can use some drugs with anti-swelling effect on blood vessels, such as Aescuven Forte, Indomethacin suppository and so on. At the same time, it is necessary to reduce the intensity of walking and other rehabilitation training, and raise the affected limbs, promote blood circulation, so as to make venous reflux smoother.


Infection after hip arthroplasty is a disaster

After hip arthroplasty, patients need to be particularly careful about joint infection, because once infection occurs, patients will face repeated or even multiple operations, which can be described as a catastrophic consequence. At present, the lowest infection rate after total hip arthroplasty in the world is between 1 ~2 and in China, the infection rate after total hip arthroplasty is between 2 ~5. Generally speaking, the following three groups of people are susceptible to infection:

1. Patients with poor resistance;

2. Patients with diabetes, anemia and other diseases before surgery, leading to poor function of other organs;

3. Patients with poor skin condition and previous trauma before hip arthroplasty;

4. Long-term use of hormones or immunosuppressants.

In addition, it is worth noting that the infection rate of hip arthroplasty caused by different causes varies. Among them, for patients with inflammatory joint diseases such as rheumatoid arthritis or ankylosing spondylitis that require replacement of the artificial hip joint, the postoperative infection rate is 2.7 times higher than that of the causes such as femoral neck fracture and femoral head necrosis. Therefore, the prophylactic use of antibiotics for 1~2 days is recommended. Postoperative use of antibiotics is also slightly longer; More than two years after the operation, if other parts of the body appear infection, such as skin infection, urinary tract infection, pneumonia, must also use antibiotics to protect.

Generally speaking, joint infection after hip replacement can be divided into acute infection and chronic infection. Acute infection is characterized by redness, swelling, heat, pain, and pus. In the case of chronic infection, the most obvious symptoms are pain, such as resting pain (when the patient stays still and does nothing, but still feels pain in the joints), weight-bearing pain (when the patient steps on the ground), and nighttime pain. Now most of the infections that occur after hip replacement are chronic infections, where the bacteria are not so bad that they make the wound red, swollen, hot, and only painful. When infection is suspected, patients need to seek medical advice in time and go to the hospital for X-ray, examination of erythrocyte sedimentation rate, c-reactive protein and other items to make a clear diagnosis.


How long can artificial joint be used after total hip joint replacement?

After hip replacement, how long can the new joint be used is a question of great concern to patients and their families. In fact, with the widespread use of new technologies and materials, the service life of artificial hips has been greatly improved. For example, ceramic technology has been developed from the first generation to the fourth generation, and the plastic polyethylene lining has also been developed from ordinary polyethylene to cross-linked polyethylene. With the use of high cross-linked polyethylene, the wear-resisting degree is getting better and better. The study found less than 0.1 millimeters of wear per decade. It can be said that with the use of new materials, the failure rate of prosthesis due to friction has become lower and lower.


Immediate medical treatment in three cases after hip replacement

With the continuous development of science and technology and the continuous improvement of surgical techniques, the hospital stay of patients after hip replacement is greatly shortened, and many postoperative rehabilitation training and nursing are gradually completed at home. However, for patients who are not professionals and may face various problems after surgery, they are often hesitant about whether to seek medical treatment. They are afraid of big problems if they do not seek medical treatment, and afraid that it is just a false alarm. In fact, patients need immediate medical attention if they experience any of the following symptoms:

1. Hip dislocation occurs

It is important to know that even after many years of hip replacement, dislocation of the hip may be caused by improper posture or trauma. In case of hip dislocation, reduction or revision should be considered and immediate medical attention should be sought.

2. Postoperative wound purulence

If the wound turns red after the operation and starts to purulent and watery, then it is highly suspected that infection will occur and immediate medical treatment is needed.

3. Continuous pain after operation

Patients always feel pain after surgery, and even worse, they need timely medical treatment.

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