Sick leave after hip surgery. How many sick days after hip arthroplasty

Article publication date: 08/03/2016

Date of article update: 05.12.2018

Rehabilitation after hip arthroplasty is an integral stage postoperative treatment aimed at restoring muscle tone and leg functionality. Rehabilitation consists in limiting (features) of physical activity in the period after surgery and in performing physiotherapy exercises.

Principles recovery period after hip arthroplasty:

• early start,
• individual approach in carrying out rehabilitation activities,
• subsequence,
• continuity,
• complexity.

Rehabilitation after arthroplasty has three periods: early, late and remote. For each of them, a specific gymnastics complex has been developed. The total duration of rehabilitation is up to a year.

Restoration of leg performance begins even in the hospital, where the patient underwent surgery. The approximate length of stay there is 2-3 weeks. You can continue rehabilitation at home or in a rehabilitation center, and finish it in a dispensary or a specialized clinic for rehabilitation treatment. If you work out at home, it is important not to interrupt exercise therapy and therapeutic walks so that the recovery takes place in full - only then the musculoskeletal apparatus will securely fix the artificial joint, and all leg functions will be restored.

Lack of rehabilitation after arthroplasty threatens with the occurrence of dislocation of the endoprosthesis head due to ligament weakness, periprosthetic fracture, development of neuritis and other complications.

Rehabilitation after any type of joint surgery, including hip replacement with an endoprosthesis, is carried out by a rehabilitation doctor and (or) a physiotherapy doctor. He will create an individual program taking into account physical condition the patient, the degree of adaptation to physical activity, his age, the presence of concomitant diseases.

After the installation of the endoprosthesis, it is possible to restore the ability to work. Persistence, desire to recover, strict implementation of the recommendations of doctors are the main criteria positive result rehabilitation after hip replacement surgery.

Three periods of rehabilitation

Early rehabilitation period after arthroplasty

This period begins immediately after recovery from anesthesia and lasts no longer than 4 weeks.

Six Rules of the Early Period

Sleep on your back for the first few nights after hip replacement surgery;

you can turn on your healthy side with the help of a nurse at the end of the first day after surgery, on your stomach - after 5-8 days;

do not make sharp turns or rotations in the hip joint - this is contraindicated;

do not bend the affected leg so that the angle of flexion is more than 90 degrees;

neither bring together nor cross your legs - put a wedge-shaped pillow between your legs;

Do simple exercises regularly to prevent blood stasis.

Early Goals

• Improve blood circulation in the operated hip area;
• learn how to sit in bed correctly, then get up from it;
• prevent the development of complications (pressure sores, thrombosis, congestive pneumonia, pleurisy);
• accelerate the healing of the postoperative suture;
• reduce swelling.

Basic exercises

In the table - exercises for the calf, gluteal, femoral muscles of both legs:

(if the table is not fully visible, scroll to the right)

Exercise rules:

• make several visits per day, spending 15-20 minutes from each hour during the day;
• keep a slow and smooth pace;
• combine exercises with breathing exercises according to the following scheme: with muscle tension - a deep breath, with relaxation - a long exhalation;
• do breathing exercises to avoid congestion in the lungs.
• first, do exercises in the early period only while lying on your back (although you need to get up on your feet already for 2-3 days), and then do the same gymnast while sitting on the bed.

A set of exercises for rehabilitation after arthroplasty

I presented the exercises described in the table above in the order of their implementation, they are relevant throughout the entire rehabilitation course. This exercise therapy complex is suitable for the rehabilitation of patients after almost any operation on the joints of the legs.

Additional exercises

In the first 2-10 days after arthroplasty, doctors teach the patient to sit on the bed correctly, roll over, stand up, and walk on crutches.

Having already learned to keep balance and lean on the operated leg, the patient must supplement the complex with other exercises - they must be done every day from a standing position, holding on to the headboard or chair. Here they are:

(if the table is not fully visible, scroll to the right)

The sooner the patient starts to get up and walk after arthroplasty, the less likely it is to develop muscle (limitation of mobility) in the hip area.

Late postoperative rehabilitation

Late rehabilitation after hip arthroplasty begins 3-4 weeks after surgical intervention and lasts up to 3 months. The duration of rehabilitation for each patient varies depending on his age and other factors.

Two goals of the late period:

muscle training to strengthen them, increase tone,

restoration of range of motion in the joints.

After the patient already confidently gets out of bed, sits on a high chair, walks on crutches for 15 or more minutes 3-4 times a day, the motor regime is expanded by training on an exercise bike (no longer than 10 minutes 1-2 times a day). Also, the patient is taught to walk up the stairs.

Climbing a step, start with a healthy leg, substituting the operated one to it. When descending, lower one step lower: first crutches, then a sore leg and then a healthy one.

Remote rehabilitation period

This period begins 3 months after the hip arthroplasty; and last up to six months or more.

• full restoration of the functioning of the artificial joint;
• acceleration of bone regeneration;
• improvement of the functional state of ligaments, muscles, tendons.

Adaptive motor mode involves preparing the patient for more intense physical activity and adaptation in everyday life. Exercise therapy is supplemented with physiotherapy (mud or paraffin applications, balneotherapy, laser therapy and other physiotherapy).

Exercises to do at home

Later the above gymnastics early period after endoprosthetics, they are supplemented with more complex exercises.

Examples of exercises that patients perform at home after discharge. Click on photo to enlarge

(if the table is not fully visible, scroll to the right)

The last two exercises and the rest, where movements must be made with a straightened leg, are necessary after surgery on the hip joint, since they are aimed at developing hip endoprosthesis. For the recovery period when replacing another large leg joint - they are only additional.

Step platform

Gymnastics on simulators

The adaptive motor mode in the long term is expanded due to physiotherapy exercises on simulators. By this time, the ligaments and muscles have already become sufficiently strong after the operation, so the intensity of the loads can be increased. The table below shows the most common exercises to fully restore range of motion in the hip joint.

(if the table is not fully visible, scroll to the right)

Conclusion

At each stage of rehabilitation, the control of a physiotherapy doctor is important. He will tell you when you can complicate the exercises, increase the load.

Self-execution of exercises for the hip joint after arthroplasty, especially with the use of simulators, can lead to serious consequences. You cannot do gymnastics through pain or, conversely, stop it ahead of time, even if you feel good and the endoprosthesis, as you think, moves well. Only the precise fulfillment of all the tasks set by the doctor will make your new joint work fully.

Owner and responsible for the site and content: Afinogenov Alexey.

Your comments and questions to the doctor:

Victor | 07/06/2019 at 19:43

Hello. I am 67 years old. On March 15 and September 19, 2018, he underwent surgery for arthroplasty of the left and right hip joint (1 year 4 months, 10 months expired, respectively). Couples metal+polyethylene+ceramics. Non-cementing. Rehabilitation is going well, I move around without crutches and canes, I drive a car, I passed the driver's commission without any problems. I don't feel pain or discomfort. Tell me, please, what LIFETIME restrictions exist for such operations? Is it allowed: 1. In a sitting position, placing the foot of the right / left foot on the knee of the opposite leg in order to put on socks without assistance? 2. Full (deep) squat? 3. In a standing position, bend forward, hands on the floor? (washing the floor) 4. Swimming with scrolling fins in the pool, diving? (the difference in the design of the fins and, accordingly, the load on the muscles and hips). 5. In the supine position, do you place the legs behind the leg (left-right)? 6. Avoiding the use of a wedge-shaped pillow between the legs? After what period? 7. After what period of rehabilitation is it allowed (or forever prohibited?!) lifting the knees to an angle of more than 90 °? Eversion of the raised knee to the left-to the right? Thanks in advance for the detailed answer. Sincerely...

michael | 04/25/2019 at 03:25

hello please tell me the operation was done 17 days ago, the hip joint was changed, I am 28 years old. the situation is such that the muscles hurt and in the morning the leg is heavy as a stone, tell me is this normal?

Valentina Viktorovna | 03/04/2019 at 14:05

The PTB operation on 12/06/2017 still hurts the thigh and buttock, the doctor who operated said that the pain was from the back. this is possible osteochondrosis. The thigh along the seam is swollen, when touched, the feeling is as if numb, but the pain is felt. I walk with a cane on the street, and at home without a cane, I do exercises every day lying on the couch, thanks in advance.

Vladimir | 09.11.2018 at 01:20

Hello, during hip replacement, the femur burst during the subsequent operation, it was fixed with 5 ties along the length of the bone, the sutures were discharged, the recommendations were removed not to step on the leg for 3 months, which of the exercises you recommended, I can perform after the operation, 3 weeks have passed, thanks in advance for the answer

Olga | 09/17/2018 at 14:13

No fever, no pain, no redness. I will take your advice into consideration, thank you.

Olga | 09/16/2018 at 12:59 pm

Hello! ; September was arthroplasty of the right hip joint. Still very swollen leg, it is difficult to bend at the knee. When I was discharged, they said that everything would pass, but almost two weeks had passed. This was not the case during surgery on the left joint in February of this year. I live in the village, I have not yet reached my clinic. Tell me if there is any danger and what to do, thanks.

Svetlana | 09/06/2018 at 20:25

Hello, my mom (70 years old) is getting ready for a total hip replacement. She has arthritis and severe pain in her elbows and shoulders, I'm afraid she won't be able to use crutches properly. Is it possible to use a walker that has wheels on the front and legs like a chair on the side of the leaning person?

Mina Minsk | 09/05/2018 at 14:51

I had a hip arthroplasty in January.
Since then, the sensitivity of the toes has been impaired. What would you recommend to restore normal sensitivity. Thanks in advance, Mina.

Yana | 08/30/2018 at 11:14

Hello! How soon after arthroplasty can I do a full body massage? I visited a physiotherapist, she prescribed different procedures, prescribed ALIMP, she said about massage that it was early, after 3 months (a month and a half had passed). We all took off our stockings in the ward after a week, and for those who had their heels baked, the sisters cut the stockings at the heels to give freedom to the vessels. I walk for one and a half, sometimes 2 hours in the air with crutches, is that probably a lot? I want to go to the sea, why is there ice on the sea? When will a month pass after endoprosthetics - is it really impossible? Thank you!

svetlana | 08/29/2018 at 16:52

Hello! I am preparing to replace the TB of the right joint, I live on the 5th floor of a house without an elevator, will I be able to go home after the operation? If you write that there is no more than one flight of stairs. Thank you in advance.

Olga | 08/09/2018 at 15:56

IM 42 years old. They performed an operation to replace the right hip joint on 06/05/2018, i.e. two months have passed. I do gymnastics. Added an exercise bike. I walk with a cane, but my gait is uneven. I can't even lie down on the operated side (drawing pain occurs along the entire leg). I have several questions:
1) When can you break the "90 degree" rule and sit low?
2) When can the compression stockings be removed?
3) Will a straight gait recover and what can be done to achieve this?

Valery | 07/29/2018 at 17:13

I am 61 years old. On July 6, 2018, an operation was performed to replace the left hip joint. A BC metal-ceramic joint (manufacturer Zimmer) was installed. Three weeks have passed. Feeling good. Acute pain missing. Used underarm crutches. Last week one subelbow crutch. Is not it too early? And another question: is it possible to go to the sea at the end of September-beginning of October?

Alexander | 07/06/2018 at 12:37

Hello! I confess, I love to lie in the bathroom, after what time can I take a full bath after replacing the TBS, at the moment it has been almost 2 months?

Natalia | 06/24/2018 at 19:35

Good afternoon. Made 40 days ago to replace the right TBS. I go with a stick. Question: Which side should the stick be held on? On the side of the diseased or healthy leg? It's written differently on different sites. I'm holding the stick on the side of my good leg!??? Food question: How long after the operation (approximately) can I go to the pool or swim in the sea? Thank you.

Alexander | 06/17/2018 at 06:09

Hello! A month ago there was an operation to replace the TBS. I am 70 years old, can I use an elliptical trainer instead of an exercise bike for rehabilitation? I feel good, there is no pain in the joint and never was. When can I start exercising on the simulator? Thank you!

Catherine | 06/13/2018 at 06:12

Good afternoon! I am 70 years old, after the operation to replace the hip joint, 4.5 months have passed (01/25/2018), in general, nothing bothers me while I walk at home without a cane (I walked on crutches for about 3 months). But when I go out into the street I use a cane, it is worth walking 200 meters. The operated leg immediately gets tired and is looking for a place to sit down. Tell me what is the reason? I had a consultation with a doctor with pictures in May, they said everything was fine. Thank you for your reply

Olga | 05/14/2018 at 04:25

Hello! I read all the comments, many thanks to everyone, I learned a lot of useful things for myself. Question: they write that you need to exercise on an exercise bike, but I have a cardio simulator - walking, is it possible to walk and how much - I have a replacement of the left hip joint on 2.02.18. Right - severe pain, September 3, 2018. there will be an operation.

Viktor Nikolaevich | 05/08/2018 at 23:39

Hello. I am 66 years old. The operation for total arthroplasty of the right hip joint was performed on March 15, 2018. May 15 2 months after the operation. Pair cementless, polyethylene - ceramics. The seam was tightened, the seams resolved, the condition is normal. With the permission of the attending, I now walk on one elbow crutch. After the release of control pictures and examination, there was no doctor for an internship abroad. There is his absentee permission to lie on the operated side, the sensations are normal. Please tell me when it will be possible during sleep, when getting out of bed, etc. refuse to use a wedge-shaped pillow between the thighs?! And secondly: when is the best time and season (we have very hot weather and the summer is promised to be the same), is it better to have an operation on the second TBS? Thanks for the answer.

Tatyana | 04/30/2018 at 09:24

Good afternoon! In February, there was an operation to replace the vehicle, now you can get another vaccination against tick-borne incephalitis in May. Thanks for the answer.

Maryam | 04/07/2018 at 04:59

Hello! 27.02.2018 I had surgery to change vehicles. While doing gymnastics. When can I go to rehabilitation center? And when will you be able to drive? Right leg. Left hand drive car. Thanks in advance for your reply!

Sergei | 03/01/2018 at 20:28

Thanks for the answer. In the pictures with exercises Exercises to perform at home Long-term rehabilitation period No. 3, 6, 12 movements that doctors usually forbid to do. In these pictures, the movements and loads are both healthy joint. Does this mean that over time, all movements will be restored. It scares me that in life you won’t be able to tie your shoelaces and just squat down. I am 44 years old but before the injury I led an active sports lifestyle. Therefore, the question. Traumatologists do not have a unanimous opinion on the current state, either to wait another six months or prosthetics. nicrotic processes are not observed, but there is no accretion. Here you are trying to assess what can expect you after prosthetics.

Svetlana | 03/01/2018 at 08:52

Good afternoon! I have such a question. I had a hip arthroplasty in November 2016. I would like to know what I am strictly forbidden to do for life. I want to go to the gym on which simulators I can do.

Sergei | 28.02.2018 at 21:01

Good afternoon. I have a fracture of the femoral neck with displacement, intra-articular. For six months, the fracture did not heal. There is a high probability of prosthetics. Tell. After completing the rehabilitation course - a year, two, three, will it be possible to bend the leg more than 90 degrees. To what extent is it possible to restore the degree of movement of the leg without fear of joint breakage or dislocation. Knee to chest, squats, etc. Or does it depend on the brand of the prosthesis?

karina | 26.02.2018 at 15:20

Good afternoon. I want to ask, a week has passed since the operation. I have read a lot, but it is not clear how much you can walk, I am hyperactive, it is difficult for me to sit and lie down. Thank you.

Christina | 02/25/2018 at 06:23

Alex admin, thank you very much for your answer. A new one has arisen, how long should I sleep on my back after surgery? It’s just that the husband is already tired, I want to roll over on the unoperated side. It's been 2 weeks since the surgery.

To learn more…

What is endoprosthetics, and in what situations is it necessary? This is an operation to replace a joint that has been affected by arthrosis with an artificial implant. The disease is called coxarthrosis, and arthroplasty is indicated at the last stage of the disease, when coxarthrosis is already running, and conservative methods of therapy do not bring positive results.

In such a situation, hip replacement surgery is considered the only right solution, since only arthroplasty can restore the lost function of the joint and return the patient to a full life. The operation is prescribed when the doctor diagnoses the patient with the absolute destruction of the hyaline cartilage.

How to treat coxarthrosis

Treatment of coxarthrosis in each case is selected individually. It depends on several factors:

• patient's age;
• stage of the disease;
• the presence of concomitant pathologies;
• the patient's immune status.

In general, for the treatment of coxarthrosis of the hip joint, the doctor always prescribes a whole range of measures, which include the general improvement of the body. To treat coxarthrosis, traditional medicine methods are also used.

Therapeutic measures include both conservative and medical methods:

1. The appointment of muscle relaxants means that reduce muscle tension around the affected area. The drugs improve blood circulation in the joint and relieve pain.
2. The appointment of non-hormonal (non-steroidal) anti-inflammatory drugs that relieve pain. This group of drugs can be taken at any stage of coxarthrosis.
3. The appointment of drugs that restore cartilage tissue. These include arteparone, glucosamine, etc. These medicines most effective in coxarthrosis.
4. Hardware traction. It is used in order to reduce the load on the surface of the joint. Such treatment is a course and is possible with the help of special equipment.
5. Physiotherapy: phonophoresis, electrophoresis, laser therapy, cryotherapy. All these procedures are aimed at relieving inflammation and improving blood circulation in the affected area.
6. Postisometric relaxation stretching of muscles and ligaments is possible without the use of auxiliary mechanisms. The patient is active. Its task is to strain and relax certain muscle groups. During moments of relaxation, the doctor performs stretching.

Treatment of the 1st and 2nd stages of coxarthrosis

Treatment of coxarthrosis in the initial stages allows you to stop the development of the disease. If measures are taken in time, the patient will never know what coxarthrosis of the 3rd degree is. In the first two stages, conservative and medical methods of treatment are actively used.

1. Pain relievers are prescribed: non-steroidal anti-inflammatory drugs, analgesics.
2. Excluded significant load on the affected joint. The patient is transferred to a sparing mode. He is prescribed a course of special exercises.
3. Reflexology, massage.

All these methods stimulate proper blood circulation in the joint and tissues located nearby. They allow you to restore mobility in the joint, up to a complete recovery.

Treatment of the 3rd stage of coxarthrosis

At this stage it is possible to use conservative treatment(reducing stress, injections of drugs that improve blood circulation). But such therapy will be palliative, that is, it will eliminate the symptoms, but not the cause of coxarthrosis.

How is the hip joint

To clearly understand the essence of the operation on the hip joint, it is necessary to know its structure. This is a spherical joint that can rotate in three directions: sagittal, vertical and frontal axis.

The hip joint is formed by two bones connected to each other: the ilium and the femur. The femoral head is inserted into the acetabulum of the ilium. This device, in fact, is an excellent hinge with the ability to perform various movements.

hip joint in healthy condition covered with a layer of hyaline cartilage. In other words, the cavity of the acetabulum and the head of the femur are lined with cartilage.

Articular cartilage provides smooth sliding of the joints and allows you to dampen the movement of a person. Pathologies of hyaline cartilage and lead to the formation of osteoarthritis.

Classification of hip implants

The modern medical equipment market offers more than fifty types of endoprostheses. Any modification ensures the fulfillment of the physiological functionality of the joint. That is, the one that nature gave to man from birth. But the endoprosthesis has limitations regarding the service life.

With a properly performed operation, the implant will serve its owner for 15-20 years. After this period, the patient will need a second operation.

Endoprosthesis attachment methods

1. Cementless - with this method, the bone grows into the prosthesis, which has a rough surface.
2. Cement - the endoprosthesis is attached using polymer cement - a special bone "glue".

Both of these methods are very popular, but which one is preferable, there is no clear answer yet. Each method has strengths and weaknesses. More recently, a hybrid mount has been used. This option combines all the positive characteristics of both methods.

Endoprosthetics happens:

• Unipolar - only the head of the femur is subjected to prosthetics.
• Bipolar - in addition to the head of the hip joint, the acetabulum is also replaced.

Design of the hip implant

In the manufacture of endoprostheses, materials are carefully controlled. This is necessary, given the peculiarities of the use of prostheses. In the human hip joint, hyaline cartilage ensures perfect gliding. In an artificial counterpart, friction can cause rapid deformation of the prosthesis.

Therefore, implants are made of high-strength metals and polymers that can ensure a long service life.

Hip endoprostheses are made:

• from polymer plastic;
• from a metal alloy;
• from ceramics.

The most popular combination today is "metal + plastic", which has a normal period of operation. Of course, "metal + metal" is the leader in terms of reliability, ensuring the life of the endoprosthesis up to 20 years, and all this time the artificial hip joint works perfectly.

Hip Replacement

The size of the future prosthesis is carefully selected. Before the operation, the doctor communicates with the patient and explains to him possible complications and risks. The main risks are associated with the likelihood of infection in the body, thrombosis of blood vessels, large blood loss during surgery. The possibility of dislocation of the endoprosthesis is not excluded.

The patient is hospitalized a couple of days before the operation and is fully examined. The hip replacement procedure lasts from one and a half to three hours. Endoprosthetics is performed by a highly qualified doctor, since the operation is classified as complex.

First, the hip joint, which is affected by coxarthrosis, is removed, then an artificial implant is mounted. In this case, one of the above methods is used. In the postoperative rehabilitation period, the patient is prescribed anti-inflammatory analgesic drugs.

A small roller can be placed under the hip area to fix the pelvis in the desired position. A day after surgery in a hospital bed, a little activity is usually acceptable. On the second day, the doctor allows you to make some static movements and squat.

After endoprosthetics, the sutures are removed by the end of the second week.

Rehabilitation program

After 10-15 days after the operation, the patient is discharged home. At home, it is necessary, following all the prescriptions of the doctor, to carry out further rehabilitation. If complications arise after the operation, it is advisable to transfer the patient to a special rehabilitation center. There, he will be provided with the control of rehabilitation doctors and proper care.

The operated person must comply with the restrictions on the load on the artificial hip joint. This period is usually up to two months. .From 5 to 15% of all operations are complications. This percentage is getting smaller every year. This is explained by the fact that more advanced means are used, and the technique is constantly honed.

Important! In 95% of the performed hip replacement surgeries with an artificial implant, a person regains the ability to bend, move, play sports and completely returns to normal life.

The service life of the endoprosthesis is from 10 to 15 years. It should be borne in mind: the greater the load received by the prosthesis, the sooner the wear of the implant occurs. High mobility of the hip joint (applies to athletes who return to their previous lifestyle) and overweight reduce the life of the endoprosthesis.

Endoprosthesis surgery costs the patient from 2 to 10 thousand. Summing up, it should be noted that arthroplasty in such a disease as coxarthrosis is the last way to make life easier for the patient. In other words, when it becomes clear that there is no other way to get rid of the disease.

Therefore, it is impossible to start coxarthrosis, the disease must be treated on early stages. Then surgery can be avoided.

• Relieves pain and swelling in the joints with arthritis and arthrosis
• Restores joints and tissues, effective for osteochondrosis

Deforming osteoarthritis (DOA), which develops on the basis of trauma, congenital dysplastic or inflammatory disease, can lead to a serious deterioration in all life activities. This manifests itself in constant, oppressive pain, the inability to move normally and do the same work. It often leads to disability. One of the methods of treatment of DOA is arthroplasty. Many believe that after a knee or hip replacement, they automatically give disability.. Is it so?

Disability in DOA and after arthroplasty

There are a lot of indignant letters on the Internet on medical forums, something like this:

My mother, a nurse at City Hospital No. 2, underwent surgery a year ago. Since then, she has been in constant pain, especially her leg aches before a change in the weather. She can't bend her knee like she used to, she can't run. They submitted documents to the ITU, but after the operation they didn’t give her any group ... Why? ..

To understand this, let's consider the principle by which they generally give disability in diseases of the musculoskeletal system.

The basis for assigning a disability group may be:

• Deforming arthrosis of both hip or knee joints not lower than the second stage of arthrosis and a moderate degree of joint dysfunction
• DOA of one or more joints (hip, knee, ankle, shoulder, elbow, wrist) in stage III, with ankylosis or limb shortening
• Bilateral arthroplasty leading to severe disorders

Thus, in itself - is not yet a basis for disability. On the contrary, surgery can be recommended in the late stage of DOA as a method of treating arthrosis and the possibility of removing a number of life restrictions (LIA)

A person agrees to an operation, not wanting to become disabled, but on the contrary, wanting to avoid disability.

Another thing is when the joint replacement was unsuccessful for some reason:

• The quality of the prosthesis is low
• The surgeon did not conduct computer navigation and unsuccessfully selected the geometric dimensions of the prosthesis
• After the operation, the patient did not undergo rehabilitation or did not go through it as it should

A referral to the MSE after arthroplasty is given in the event of moderate and severe musculoskeletal disorders that led to the limitation of the patient's life activity (OIA)

Let's consider how the degree of musculoskeletal functions is determined and by what criteria the OZhD is evaluated at the ITU.

Medical and social expertise in deforming arthrosis

Post-traumatic arthrosis is considered the most unfavorable in its course, since it differs:

• The most pronounced dysfunctions (contractures, restriction of movements, shortening of the leg, muscle atrophy)
• Increased frequency of exacerbations
• The rate of disease progression

For MSE, the following criteria for assessing the patient's condition are required:

1. X-ray diagnostics according to Kosinskaya
2. Functional diagnostics
3. Determination of the degree of statodynamic function (SDF)
4. Determination of the degree of moderation in the development of DOA:
   • How quickly the disease progresses
   • How often do exacerbations occur?
   • What are the complications of the disease

X-ray diagnostics at ITU

Diagnostics at medical and social expertise differs from the usual diagnosis that is used in modern medical practice:

• So, the degrees of arthrosis in medical orthopedics on the basis of x-rays are today determined according to the Leuquesne classification - it distinguishes four degrees of arthrosis
• At ITU, the degrees of arthrosis are determined only according to the classification of Kosinskaya (three degrees)

The third degree according to Leuquesne may correspond to the second according to Kosinskaya, which may cause disputes.

Degrees of DOA according to Kosinskaya

First degree DOA:

• Slight restriction of movement
• Mild and uneven narrowing of the interarticular gap
• Initial osteophytes

Second degree DOA

• Restriction of joint movement in certain directions
• The appearance of a rough crunch when moving
• The narrowing of the gap by two to three times, in comparison with the norm
• Moderate muscular atrophy
• The appearance of large osteophytes
• Signs of osteosclerosis and cystic cavities in the epiphysis of the subchondral bone

Third degree DOA

• Large joint deformities and compaction of bone surfaces
• A sharp limitation of mobility with the preservation of rocking movements in the range from 5 to 7 ˚
• Large osteophytes over the entire surface of the joint
• Joint gap closure
• Fragments of cartilage in the synovial cavity of the joint (articular mice)
• Subchondral brushes

With complete fusion, not DOA is diagnosed, but ankylosis, which is informally considered the fourth stage of arthrosis

Functional diagnostics in arthrosis

There are four degrees of limitation of joint movements:

First degree:

• Limitation of movements of the shoulder, hip joint - no more than 20 - 30 ˚
• The amplitude of the knee, ankle, elbow, wrist joints is not less than 50 ˚ from a functionally advantageous position
• Brush amplitude - from 110 to 170 ˚

Second degree:

• Restrictions of hip movements and - no more than 50 ˚
• Knee, elbow, wrist - decrease in amplitude to 20-45 ˚

Third degree:

• Preservation of the amplitude within 15 ˚, or ankylosis and immobility in a functionally uncomfortable position

Fourth degree:

• Fixation of the joints in a tightened functionally uncomfortable position

Degrees of statodynamic function (SDF)

In many respects, the maintenance of these functions, thanks to which we continue to maintain support and move even in the later stages of osteoarthritis, occurs with the help of compensatory processes, the purpose of which is:

• Eliminate the difference in the lengths of the limbs due to the distortion and inclination of the pelvis
• Alleviate contracture leading to limb shortening by increasing mobility of adjacent and contralateral (opposite) joints
• Improve the support of the diseased limb by transferring the load to the healthy leg, etc.

Apart from clinical signs(shortened limb, pelvic tilt and muscle atrophy of the diseased limb), compensation is confirmed by X-ray:

• Bone sclerosis is observed in the most loaded area of ​​the joint
• The support area of ​​the joint increases
• In the diseased joint, signs of osteoporosis and cystic degeneration are observed.
• In adjacent joints, the opposite joint of a healthy limb and the lumbar region, DDD begins

There are four degrees of SDF:

Minor violation of SDF

• Amplitude reduction no more than 10 ˚
• The appearance of aching pain after a deadlift or walking three to five km at a pace of 90 steps per minute
• Pain goes away after rest
• The first stage is determined by x-ray
• Compensation indicators are normal

Moderate SDF violations

Moderate violations (initial stage)

• Pain and lameness when walking 2 km, disappearing after rest
• Stride pace - 70 to 90 steps per minute
• The average number of steps at a distance of 100 m is 150
• moderate contracture
• Support shortening - no more than 4 cm
• The circumference of the affected thigh is reduced by two centimeters
• Muscle strength is reduced by 40%
• X-ray determines the first-second stage of DOA
• Musculoskeletal functions and compensatory mechanism correspond to the degree of relative compensation

Moderate violations (late stage)

• The patient complains of constant pain in the joint, lameness, pain when starting to move.
• He is able to walk no more than one kilometer, and then with the help of a cane
• Walking pace from 45 to 55 steps per minute with the number of up to 180 per 100 m
• Arthrogenic contracture is expressed
• Shortening of the limb - from 4 to 6 cm
• Hypotrophy progresses:
  • The difference in the girth of a healthy and diseased hip reaches from 3 to 5 cm
  • Healthy and diseased lower leg - one - two cm
• Decreased muscle strength - 40 - 70%
• X-ray determined the second - third stage of DOA
• in the joints lumbar and lower extremities changes begin without neurological symptoms
• The mechanism of compensation corresponds to the degree of subcompensation (compensation is insufficient, its tasks are difficult to accomplish)

Severe violations

• Intense pain in the diseased joint, in the lumbar and contralateral joint
• Pronounced lameness, inability to walk more than 0.5 km without rest (using a cane, one or two crutches)
• Walking pace from 25 to 35 steps per minute, with at least 200 steps per 100 meters
• Severe arthrogenic contracture
• Shortening of the limb - more than 7 cm
• Hypotrophy of the thigh in the difference in the lengths of the circumferences of the patient and healthy thigh - more than 6 cm, hypotrophy of the lower leg - more than 3 cm
• Reduced muscle strength - more than 70%
• According to X-ray - the second - third stage
• Degenerative-dystrophic changes in the joints of the extremities and lumbar spine with neuroradicular syndrome
• This stage corresponds to the musculoskeletal functions of decompensation (complete impossibility of compensation)

Significantly pronounced changes in SDF

• This is actually the inability to move independently
• The patient mostly lies and moves with great difficulty only within the apartment, with outside help or with the help of crutches (walkers)

Types of the course of the disease

Slowly progressive:

• It takes at least 9 years from the onset of the pathology to the appearance of pronounced changes.
• By type of compensation - compensated arthrosis
• Synovitis exacerbations are rare (once every one to two years)
• No reactive synovitis

Progressive:

• Process development time: 3 – 8 years
• Subcompensated type of arthrosis
• Secondary reactive synovitis with exacerbations twice a year
• There are signs of cardiovascular disorders: hypertension, atherosclerosis

Rapidly progressing:

• Arthrosis develops within no more than three years
• Decompensated type
• Reactive synovitis with exacerbations at least three times a year
• Associated pathologies

Basis for assigning a disability group

Minor persistent violations of the SDF in the first and second stages of arthrosis of one joint are not the basis for assigning a disability group

• The basis for the establishment of the 3rd group may be persistent moderate dysfunctions of the SDF:
  • The third stage of DOA of the hip joint or bilateral (gonarthrosis) of the second stage with the first degree of limitation of the range of motion of the joints
• Reasons for the second group of disability - persistent pronounced violations of the SDF, leading to the second degree of mobility restriction
  • Bilateral coxarthrosis with severe contractures 2-3 stages
  • Ankylosis of the knee, ankle and hip joints
  • coxarthosis and

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Based on the foregoing, we denote that a certain percentage of patients do not fit into the generally established standards of rehabilitation. At the end of 90-120 days after arthroplasty with unsatisfactory clinical picture the issues of granting the status of VUT to the patient will already be dealt with by the expert commission of the ITU.

To do this, the medical institution (HCI), where the patient was treated and examined during the entire rehabilitation period, sends a package of documents to the local bureau. The parcel package necessarily includes all extracts and conclusions on the main diagnosis, on diagnostic and therapeutic measures carried out in outpatient and stationary conditions. That is, the health care facility, according to the collected documentation, officially confirms the fact that the patient has depression of functions of one nature or another and the need to undergo specific medical rehabilitation.

Experts medical and social commission carefully study the information received from the health facility about the patient and pass a verdict on the degree of limitation of his performance. The ITU, as one of the most common options, can agree that the polyclinic opens a new one from the date of closing the sick leave until the patient's quality of life is restored to the fullest extent possible. The terms of the BL are also set for the health facilities by the ITU, however, as well as the admissibility of its extension without their participation, the cyclicity of the update. Another option, less likely, is that the expert commission assigns a disability group (usually 3 gr.) to the patient with its further re-examination at the time indicated by the MS-instance.

We emphasize that MSEC reserves the right to refuse both the extension of the BC and the assignment of the group if the pathological deviations are confirmed as minor.