Thanks to advancing prosthesis biomechanics and developing surgical techniques, hip and knee prosthesis operations are performed very frequently today. Hip and knee prostheses have high success rates. However, the results of shoulder prosthesis operations, which are performed less frequently, are not as successful as those of the hip and knee.
When should prosthesis operations be performed?
The time of the prosthesis operation depends on the individual and the degree of the disease. It varies depending on. If the patient's quality of life is not greatly affected by the deteriorating joint, surgery is generally not recommended before the age of 65. Since the patient will live with that prosthesis throughout his life, the operation is irreversible. Therefore, patient selection must be made extremely carefully. All alternative treatments for that joint of the patient should have been tried. On the other hand, there are some drawbacks to delaying the prosthesis in a patient who has failed all the treatments tried and who absolutely requires a prosthesis. As other system diseases such as heart and blood pressure may occur or existing ones may progress with age, the complication rate of the surgery increases and the success rate decreases.
How long does the implanted prosthesis last?
People who have had a successful hip-knee prosthesis operation can use these prostheses for 15-25 years, depending on the level of activity. Prostheses made especially in young patients may loosen in a shorter time due to the high activity rate in these people. In this case, the patient needs to go to revision surgery again and, if possible, replace the prosthesis. The success rate is lower in these second surgeries.
What are the factors that determine the success of the prosthesis?
Factors affecting the success of a prosthesis operation; Correct patient selection, surgical technique applied, physical therapy and rehabilitation applied to the patient before and after the prosthesis operation.
Nowadays, it is more or less clear which patients should go for the prosthesis operation. Surgical techniques have now advanced and these operations can be performed even at the assistant level. The most neglected point to consider is pre- and post-operative physical therapy and rehabilitation.
Why is pre- and post-operative physical therapy and rehabilitation necessary? Is it?
In patients considering hip or knee prosthesis, the muscles that operate that joint have weakened because the joints are underused due to pain and deformity. Joint movements are also generally restricted due to secondary soft tissue problems. If the patient goes to the operation without being included in a physical therapy rehabilitation program, the prosthesis will only relieve the pain and the patient may not be able to use the prosthetic joint effectively and efficiently. However, with a 15-session physical therapy rehabilitation program applied before the operation, hardened tissues are loosened, joint movements are opened as much as possible and muscles are strengthened. This is especially important in hip prosthesis operations where a near-normal range of motion is expected.
Prosthesis operations are major operations and it is inevitable to damage many tissues when placing the mechanical joint. During the surgery, some muscles, ligaments, tendons and veins are cut. After the operation, the patient's joint is edematous, swollen, painful and limited. The only condition for effective use of the mechanical joint installed after the operation is physical therapy and rehabilitation at this stage. In order to ensure the stability and longevity of the implanted mechanical joint and to use it close to the biomechanics of the normal joint, it is essential that the patient's joint movements are restored and the muscles are restored to their former strength. Giving home exercises to a patient with a prosthesis has no place in modern medical doctrine. All that the operation provides us with is a painless joint. What we want is a painless and functionally adequate joint. If a patient who has had a prosthesis operation due to hip arthritis still walks with a limp or still has someone else put his socks on, or if a patient with a knee prosthesis still cannot climb the stairs without assistance, the result is functional failure, no matter how good the surgical technique is. For this reason, after the prosthesis operation, it is necessary to restore normal range of motion to the knee and hip joints and regain the lost muscle strength. With physical therapy applications and some devices used, the patient's pain and edema resulting from surgery are eliminated and the joint movement limitation is relieved. Muscles are strengthened with exercises performed by a physiotherapist. For this purpose general A physical therapy rehabilitation program of 20-30 sessions is sufficient. In this way, the patient's joint becomes both painless and functional. More importantly, with these applications, the long-term success of the prosthesis increases and the complication rate decreases significantly.
For these reasons, patients should go for the operation after meeting the post-operative physical therapy and rehabilitation conditions. Physical therapy, which was started after surgery in the hospital, should be continued at home if necessary after discharge, and should be continued on an outpatient basis when the patient is well enough to go to a hospital or clinic.
Pre-operative rehabilitation may not be possible in some cases, but it should not be forgotten that post-operative rehabilitation It is an indispensable part of prosthetic operations. It should definitely not be neglected. Otherwise, the functional success of the prosthesis operation will be greatly negatively affected.
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