Functional treatment for hips with applied endo-prosthesis in the “Lacu-Sarat Braila” recovery center (2009-2013)

Abstract

The present study focuses on the necessity and efficiency of the kinetic recovery of the operated hip, and on increasing the orthopedist’s trust in the kinetic act as a medical act executed in a responsible and understanding fashion by qualified staff. Arthroplasty refers to the replacement of a joint deteriorated by a certain pathological process (degenerative arthritis, infection, or tumor) with an artificial one, named endoprosthesis, a joint which must remain perfectly functional. The lot comprised 76 (63%) male patients and 45 (37%) female patients, 44 (37%) of which with ages between 40 and 60 years, 54 (45%) between 60 and 70, and 21 (18%) over 70 years of age. The distribution of the study lot was made depending on the addressed symptomatology: chronic pain, acute pain and mobility reduction. Thus, 52 (42%) patients featured acute pain, 42 (33%) chronic pain and 35 (27%) mobility disorders accompanied by walk disorders, that is, tilting pelvis 67 (55%) and limping 54 (45%) (Figs. 3-4), with hip prostheses of different types and at various intervals from the intervention. Subjects were clinically, functionally, radiologically and MRI investigated, preoperatively, postoperatively, after 3 months and after 1 year. A recovery program featuring educational, hygienic, diet, medication and physical-kinetic aspects was applied daily for a 14 to 15-day period, followed by kinesiotherapy and massage 2 to 3 times a week, by reevaluation and by a complete treatment at 3 months and at 1 year, respectively. Monitoring was made by the VAS scale for pain, Womac Lequesne for the functional status and Tinetii for the walk. Results. All patients have been evaluated initially, after 10 days and at the completion of the treatment, after 3 months and after 1 year. The recovery of hip arthroplasty must be carried out in time and maintained for the entire life. We concluded that hips with applied endo-prosthesis must present the same functionality as a normal joint. If mobility is restored by the very functionality of prosthesis as passive element, stability and walk require a 4-5 force musculature, values that can be obtained only through an analytical kinesiotherapy program for each muscle group. Due to the fact that the application of endoprostheses occurs between the ages of 60 and 80 years, the reeducation of the walk is slow, and the fear of falling hinders recovery, which is an issue with great impact on the quality of life.