Joint replacement in elderly patients at ECSTO

Orthopedic surgeonsEuropean Clinic of Sports Traumatology and Orthopedics (ECSTO) both scheduled and emergency services are being successfully performed endoprosthetics of joints for elderly patients. Just the other day, our specialists performed such operations on two women, aged 85 and 80.

In elderly patients with femoral neck fracture, osteosynthesis (fastening broken bones with metal clamps) is impractical, says Professor, Deputy Chief Physician of ECSTOAndrey Kardanov(Prof. Andrey Kardanov). – Such an operation always involves a long-term (up to 6-8 months) limitation of the load on the leg, and it is impossible to put an 85-year-old patient on crutches while waiting for her bone to heal, which is why hip arthroplasty is performed in such cases. Moreover, the probability of fusion of a femoral neck fracture in the elderly is approaching zero, while arthroplasty allows you to return to your usual lifestyle in just 2-3 weeks. As for the other patient, this was her second surgery. Four months ago, I replaced one of her destroyed knee joints, but since the joint of the other leg was also destroyed, which caused pain due to increased physical activity, she came to us again. Both patients were successfully operated on and discharged a week later."

In many hospitals, surgeons refuse to operate on elderly patients due to the risk of life-threatening complications, however, if surgery is not performed with joint destruction or hip fracture, the person will permanently lose the ability to walk and may die from pathologies developing as a result of bed rest or decreased motor activity, for example, pneumonia or thromboembolism. In addition, constant pain is a source of high blood pressure, stress ulcers, and increased blood sugar levels.

In ECSTO elderly patients are carefully examined and prepared for surgery not onlyanesthesiologists and surgeons, but also internists, cardiologists and neurologists. A set of measures is prescribed that reduces the risks of negative effects on the body of surgery and anesthesia. As a rule, after a day of surgery, patients are transferred to a regular ward, and after 7-8 days they go home on their own feet.

Any joint can be replaced, but in more than 90% of cases it needs to be replaced hip and knee, especially when it comes to the elderly.

Today, our surgeons have many different modifications of endoprostheses, both hip and knee joints. In elderly patients, the most important parameters determining the choice of an endoprosthesis are those that allow a person to lead a habitual lifestyle after surgery, without remembering about the artificial joint at all. In particular, endoprostheses with a large head diameter are used to replace the hip joint, which eliminates postoperative dislocation even with very weak muscles or concomitant neurological diseases. The most recent example is from Prof. Kardanova:"Revision hip replacement surgery in an 82-year-old patient with recurrent dislocation of the endoprosthesis head, installed in Germany 6 years ago. For 5 years after the operation, there were no problems with the joint implanted by German colleagues, however, during the last year after suffering from neurological diseases, the muscles of the operated leg became noticeably weaker, which caused dislocations of the endoprosthesis head during the most common movements. Each dislocation required correction under general anesthesia, and the head of the endoprosthesis had to be adjusted openly once. We had no choice but to replace the two components of the German joint – the cup and the head. The newly installed components eliminate the very possibility of dislocation, while allowing full use of the leg. Of course, revision prosthetics is a more technically complex and more complicated operation, but in this case everything went according to the most favorable scenario."

endoprostheses with cement-free fixation in the bone are usually used, however, if pronounced osteoporosis (bone softening) is detected intraoperatively, the surgeon opts for cement fixation, which, as in the first case, allows you to put a full load on the leg the next day. the day after the operation.

When choosing the type of endoprosthesis to replace the knee joint, it is important to focus on the condition of the ligamentous apparatus of the knee. In a situation where there is a pronounced imbalance or long-standing damage to the ligaments of the knee joint, the use of a stabilized endoprosthesis is required. The design of such a joint makes it possible to use the leg perfectly normally, even in the complete absence of ligaments. The knee arthroplasty is always fixed to the bone with the help of bone cement, which allows you to start rehabilitation and walking with a load at the same time as after hip replacement.

There is an opinion that endoprosthetics is an operation involving heavy blood loss. However, with the correct actions of the surgeon, when the operation lasts an hour and a half, and the tissue incisions are minimal (7-10 cm for the hip and 12-15 cm for the knee), blood loss is about 200-400 milliliters. In rare cases, when blood replenishment is still required (severe post-traumatic arthrosis, complex revision arthroplasty, prosthetics in oncology), the necessary blood components are always available in the intensive care unit of the clinic.

"We bring back the joy of movement," is the motto of our clinic, so following it, we believe that everyone has the right to an active life, regardless of age. 70, 80, 90 years is not the limit,— concludes Andrey Kardanov. — People should walk on their own two feet to the last, and that is why we strive to operate on elderly patients, giving them a chance to continue to live normally. Literally next week, a knee replacement is planned for an 86–year-old patient. He not only continues to work, but also drives a car and does physical education at his home gym. A timely low-trauma operation, adequate postoperative management and rehabilitation guarantee our patients the opportunity to move without pain, continue to serve themselves, and not be a burden to others.