Endoprosthesis of the hip joint - TEP of the hip

Have you been operated with a replacement of the hip joint, and you would like to know more about the post-operational phase, than what you have been told in the hospital? Or you are waiting to be operated and you want to prepare? We hope that in the following article you will find answers to all your questions. If not, then don't hesitate and contact us!

HIP JOINT

The hip joint is the biggest joint in the human body, and it is composed from joining the thigh bone with the pelvic bone. It is a simple joint, but thanks to its strong ligaments which are surrounding it, it is also the strongest joint. Within the lower part of the body, the hip joint has the biggest range of mobility of all the other joints.

WHAT DOES THE TEP OF THE JOINT MEAN?

TEP is an abbreviation for total endoprosthesis, meaning complete replacement of the joint. It is artificial replacement of the head of the thigh bone and the joint socket of the pelvis. According to the range of damage, the doctor will decide whether it will be enough to replace just the head of the thigh bone, or whether the joint socket has to be also replaced due to the extent of the damage. Complete replacement signifies replacement of both surfaces that are in contact (the head and the socket).

In modern medicine exists a huge amount of shapes, and materials and operational approaches. Endoprosthesis can be made out of metal, polyethylene, ceramics or made out of combination of these materials. Some implants are attached to the bone with bone cement, and others without it. The bone cement is usually applied to elder patients.

THE MOST COMMON INDICATION FOR TEP OF THE HIP JOINT

  • Traumatic fractures of the neck of the thigh bone
  • Arthrosis of the hip joint - degenerative disease
  • Avascular necrosis (cellular death of bone tissue, forming without the presence of infectious inflammation, no clear cause)
  • Congenital defects
  • Rheumatoid arthritis (inflammatory autoimmune disease manifesting especially with inflammation and pain of the joints and their subsequent damage, which can affect also other organs)
  • Oncological causes

Preoperative assessment

Before the surgery, it is necessary for your doctor to internally examin you, evaluate the degree of risks, estimate whether you are able to undergo this operation, and assist on the optional choice of anesthesia. Usually general anesthesia is used, in some cases you can ask for spinal anesthesia, which will „deaden” the you only from your waist down, so you will stay conscious. In the day of operation you will be treated by a doctor - orthopedist (usually the surgeon), who will explain you the process of operation, as well as the process of post-operational phase. Before operation, the doctors take patient's blood, which is then used as autotransfusion, if there is a need to replace the lost blood.

CONTRAINDICATIONS

Certain circumstances or conditions of the patient exclude the possibility of operation. Contraindication can be split into two groups:

Local contraindication

  • Infection in the ankle
  • Skin infection, pressure ulcers, boils
  • Folliculitis - staphylococcus skin infection

General contraindication

  • Patient is not cooperating
  • The condition of the patient, disabling walking after the operation
  • Inflammatory source
  • Allergy to artificial material
  • Bad quality of the bones
  • Neurogenic arthropathy - degenerative diseases manifesting by lost sensitivity

DAY OF THE OPERATION

In the day of the operation, doctor will apply a dosage of anti-inflammatory drugs and antibiotics into your muscles as a part of premedication.

In most cases, the patient is lying on the side. In the first phase the damaged In the first stage the damaged parts of the bone are removed, and then it's replaced by the prosthesis. It is very important to check the stability of the of the endoprosthesis. The cemented replacements are attached with the bone cement, by non-cemented replacements the stability is secured by the processed surface of the replacement. Then wound is then sewed together. The whole surgery takes around 90 minutes.

POST-OPERATIONAL PHASE

Immediately after the operation you will be transferred to the intensive care unit, where you will receive anti-inflammatory drugs, drugs against pain and your life functions will be monitored. If there won't be any complications, you will be transferred the second day to a standard room. As a prevention against thromboembolic diseases, compression stockings are ideal. Another step in the post-operational phase is differing in every medical facility. Some facilities enable the patients to stand right up the second day after the operation, some after three days, it depends on the hospital regulations and traditions. But after the third day from operation you should be able to stand up and walk with crutches. The used type of the crutches again depends on the tradition of the hospital, availability and willingness of the personnel. Underarm crutches put pressure on the blood vessels and nerves in the underarm area and they burden the shoulder joints. It is more ideal to use forearm crutches (getting the support in the hands and forearms).

Exercising after the surgery

Getting up from bed several times a day and walk with the crutches is important, rather more frequently with smaller distances. In the meantime you need to exercise not only the operated leg, but your whole body while you are lying down as well as sitting on the bed.

What to avoid after the surgery?

It is necessary to pay attention to your movements in the operated hip joint, so that the joint would not be released from the socket. These principles have to be kept at least 3 months after the operation.

Patient after the operation of the TEP hip joint cannot do these 3 basic movements (and their combination):

  • Rotation in the hip joint - especially not rotating the toes outwardly
  • Flexing the hip joint above 90° - deep sitting posture (tying shoes, bending down)
  • Lifting the extended leg into the air

Forbidden combination of these movements is putting one leg across the other!

PHYSIOTHERAPY AFTER TEP OF THE HIP JOINT

Soon after the post-operational phase, the physiotherapist will focus on the treatment of the soft tissues, which were severed during the operation. Important is also the care for the scar, in order to stop the adhesion of single layers of the skin and subcutaneous tissues and fascitis, which cover the muscles. It is necessary to apply soft tissue techniques to relieve this area. Ideal is also gentle pressure massage, stimulating massage, or taping (supporting the joints and muscles in the problematic areas, thanks to special cotton band sticked to the skin), which can not only relieve the area but it can also help to absorb the hematoma which are often accompanying the post-operational period. Before the exercise itself, it is important to relieve the hypertonic and tensioned soft tissues and muscles. Increased tension after operation is troubling especially the flexors of the legs as well as the extensors of the knee joints. On the other hand, the gluteal muscles are weakened, as well as the front side of the thighs and abdominal muscles. Isometric exercises (during which the length of the muscle is not changing, only the tension is changing; the angle of the active joint stays unchanged) can again strengthen these muscle groups. After the stitches are removed and the wound is healed, it is optional to apply a therapeutic laser on the scar. Important is the training of the correct walking stereotype - stepping through the heel, not rotating the toes outwardly and doing the same length steps with both feet. The degree of the burden on the operated leg and the time spent on walking with crutches is determined by the surgeon. In most cases the patient is released home after 8 - 10 days after operation.

PNF for legs

SHOCKWAVE THERAPY

It is ideal to apply the shock wave therapy on the muscles or muscles groups, which are in a higher tension. The shockwave can relieve the affected muscles and the effect is long lasting, but it is important to start with this therapy in the first stages of the illness (in a post operational phase). Application is repeated according to the needs of the patient in span of 3 - 8 application, every 3 - 5 days.

EXERCISE INSTRUCTIONS



Author:
Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic

Source: Clinical experience from a private practice in a physiotherapeutic field, FYZIOklinika

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