BRINDISI – Three bilateral hip prosthesis implants have been performed in the last six months by the team of the complex Orthopedics and traumatology unit of the Perrino hospital, directed by Gianfranco Corina. The patients, with an average age of 32 years, came to the doctors’ observation complaining of bilateral hip pain due to avascular necrosis of the femoral heads. Once hospitalized, they observed an average hospitalization period of approximately five days, they began rehabilitation from the second postoperative day and, after stabilization of the blood tests, they were discharged.
“The possibility of carrying out these interventions in Brindisi – explains Corina – allows the local population to take advantage of a service present in a few ultra-specialised centers and to limit the exodus towards other regions. Hip replacements last an average of 15 years in 95 percent of patients. Given the young age of the candidates for this type of surgery – continues Corina – the implantation of short-stemmed prostheses is essential. This technique allows you to perform a less invasive operation with bone saving, which allows you to lay the foundations for a subsequent prosthetic revision operation in which it will be possible to implant a standard stem”.
Avascular or ischemic necrosis of the femoral head is a pathological condition generated by insufficient blood perfusion which, if diagnosed late, culminates in osteonecrosis and collapse of the femoral head, inducing early arthritic degeneration. It is a highly disabling pathology that prevents walking and forces the patient to use canes or a wheelchair.
“Pain – continues the director – is usually the onset symptom. It frequently arises suddenly in the groin area, radiating towards the anterior or anteromedial aspect of the thigh and more rarely to the buttock. It is often present even at rest but weight bearing and walking contribute to significantly worsening it. It is estimated in the literature that the total number of patients affected by this pathological condition worldwide could exceed twenty million in the next decade: the pathology can arise at any age”. The therapeutic approach may include pharmacological and biophysical treatment only in the earliest phases. In most cases, surgery is necessary.
Prosthetic replacement of the hip joint is a widely used surgical technique and around two hundred are performed at Perrino every year. The simultaneous prosthetic replacement of both coxofemoral joints affected by degenerative pathology, however, is reserved only for active, young-adult patients, without or with few associated pathologies, who are not anemic or heart disease. “To perform this type of operation – adds Corina – a careful evaluation of the patient’s overall clinical status is necessary: the analysis of the candidate patient’s motivations and expectations, as well as correct information from the surgeon, are important”.
To correctly deal with this procedure, the experience of the surgeon and his team is of fundamental importance and must pay maximum attention to keeping the total time of the operation short. “The operation – explains the director – is performed starting from the most painful side. If the intraoperative clinical conditions allow it, we then proceed with the implantation of a prosthesis on the second hip in the same operating session. In this regard, a key role is played by the anesthetic team which must detect possible contraindications in prolonging anesthesia and must identify any intra- and peri-operative critical issues”.
The bilateral implant has among its advantages that of subjecting the patient to a single anesthesia, a single rehabilitation period and a single suspension from work. The surgery must be accompanied by a personalized rehabilitation protocol that allows the patient to start walking again with a rapid and safe return to their activities. Individuals who arrive at the hospital with obvious walking difficulties, sometimes in wheelchairs, undergo a rehabilitation process that allows recovery already during the post-operative hospital stay.
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