Arthroprosthetic surgery appears to be the only valid treatment solution for various pathologic diseases that affect hip joints; it is particularly advisable in case of OSTEONECROSIS of the head of the femur, of RHEUMATOID ARTHRITIS, and of TRAUMATIC CONSEQUENCES OR CONGENITAL LUXATION. Serious coxarthrosis The vast majority of these surgeries is performed because of the existence of PRIMARY ARTHROSIS. Arthrosis is a progressive wearing process of the cartilaginous components of a joint leading to a deformation of the joint surfaces. It causes pain, frequent inflammation and movement impediments; therefore it becomes particularly serious when it affects the so-called "frame joints", that is the joints that support the body weight and allow deambulation. Arthrosis tends to worsen over the years and with the use of the joint and it can lead to cases of serious functional restrictions. Most advanced forms are treated through arthroprosthetic surgery, consisting in the resection of deformed joint components with no cartilage and in their replacement with artificial coatings made of various metal alloys, separated by materials with a low coefficient of friction (plastics or ceramics). The metal components can be fixed to the bone thanks to a special resin (acrylic cement) or a simple embedding that later will foster "biological" fixing (non-cemented prosthesis). Non-cemented arthroprosthetic implant The choice among the different kinds of prosthesis is based on different factors (quality of the bone tissue, type of disease, degree of joint deformity, age of the patient). The aim of the operation is to make the joints not hurt anymore, to put them in a good axis, to give them sufficient mobility range to allow walking and most common everyday movements. We must not forget, though, that, contrary to human body tissue, prosthesis do not have any biological maintenance power and therefore, once they are implanted, they are eventually going to wear. The better the joint is used, the slower the wearing process will be in time. It is therefore vital to take good care of the operated joint, follow simple behavioural rules and take simple precautions: it is important to avoid traumatisms and useless stress, running and demanding sports activity, as well as any physically demanding job. In particular, especially during the first few months after surgery, any posture or movement that could lead to the luxation of the prosthesis, that is the disassembly of the implant with the loss of connection between the two components of the joint, will have to be carefully avoided. First of all, any exaggerated bending movement of the hip will have to be avoided (squatting, sitting down on very low armchairs, etc…); the operated limb will essentially have to be maintained in an abduct position (stretched out), and postures like "crossing legs" will have to be avoided. It is important not to gain weight because excess weight is one of the main factors for wear. Moreover, maintaining a good muscular tone, which promotes the good functioning of the prosthesis and makes luxation less likely to occur, is also considered to be a good strategy. Before the operation, a blood pre-deposit is strongly recommended (a certain amount of blood is taken from the patient) so that it is available during the operation (self-bloodtransfusion) should the need arise to compensate losses due to the operation. Moreover, we suggest to buy a pair of elastic socks to that the patient will wear after the operation to decrease the risk of deep vein thrombosis. The kind of anaesthesia used can be either general or peripheral (spinal) and it will be decided for each single patient by the anaesthetist according to his/her general conditions. In the first few hours before and after the operation the patient will have to follow an anticoagulant therapy (in order to decrease the risk of phlebothrombosis), an antibiotic therapy (to decrease the risk of infections), an analgesic therapy (only if necessary). The following POST-OPERATIVE COURSE can be described as follows: Mobilisation (both passive and active) of the hip starts on the second day after the operation (as soon as the drainage system is removed); On the third day, orthostatism and deambulation exercises with a walker can begin assisted by a rehabilitation therapist (both for cemented and non-cemented prosthesis). Patients can usually leave the hospital 8-10 days after the operation; when discharged, patients receive an informative leaflet describing the rules for preventing luxation and the exercises to do at home. Physical therapy will have to continue for about a month after leaving the hospital; Out-patients check-ups are performed: · a few days after leaving the hospital to remove stitches (in the case this did not happen during hospitalisation); · 45 days after the operation, with an X-ray of the pelvis, front-back, and of the operated hip in axial projection. After this, if the deambulation is correct and the muscular tone is good, the specialist may stop the use of crutches; · every following year, with new X-rays (see above). If urgent problems arise, it is necessary to directly phone the out-patients department in order to book an early check-up. POSSIBLE COMPLICATIONS LINKED TO ARTHROPROSTHETIC SURGERY OF THE HIP In the past few years, arthroprothetic surgeries of the hip have definitely seen an improvement of the prognosis aspects, thanks to advanced techniques and to the continuous improvement of the material used; although once considered to be a high risk surgery, today it has become a routine for the majority of orthopaedic Operative Units. However, in order to provide correct and adequate information to the patients, it is also necessary to mention the rare but possible complications (both intra- and post-operative) that might arise. Intra-operative complications: : Fractures occurring during surgical manoeuvres: usually a consequence of the poor mechanical quality of the bone tissue, they can consequently require a change in the technique and in the choice of the prosthesis: in some cases the application of a post-operation plaster might become necessary. Vascular lesions (possibili perdite ematiche anche abbondanti). Nerve lesions to the sciatic nerve. Post-operative complications: Length differences of the operated limb, both in a shorter (generally better tolerated) and in a longer way; sometimes the creation of such differences becomes necessary during the operation in order to adequately stabilise the prosthetic implant (in order to decrease the risk of luxation); Luxation of the prosthesis: it indicates the loss of connection between the two components of the new joint; most of the time it is caused by wrong movements and postures; however, it can also be caused by an insufficiency of the gluteus muscles (in fact, it appears to be very frequent during the first few months after the operation); Thrombosis of the deep veins of the leg: the signs are a large swelling of the foot and of the leg itself, a strong sense of heaviness of the limb and calf pain. In order to decrease the occurrence of such complication, it is necessary to carefully follow the heparin therapy recommended when discharged from the hospital, start the rehabilitation therapy as soon as possible and follow it consistently and, where suggested, wear the anti-thrombosis socks. Pulmonar embolism: it indicates the detachment of a thrombus that has developed in one of the veins as a consequence of the previously described complication. The thrombus reaches the lungs and causes chest pain, difficulties in breathing, cough, sometimes bronchial catarrh containing a little bit of blood. This is a very dangerous complication that requires immediate hospitalisation in an internal medicine ward. In order to prevent such complication from arising, the same preventive measures for deep vein thrombosis need to be followed. Infection: the signs of its acute form are a very high fever, strong pain in the operated knee which feels particularly swollen and hot. The signs of its subacute form, instead, are a light but constant fever, strong pain in the operated knee which appears swollen and very hot. This complication is very important but sometimes it can be solved with a new heavy-dose antibiotic therapy to be followed for a few weeks, often during hospitalisation. If this treatment does not lead to any improvement, then the removal of the prosthesis may be envisaged. Aseptic detachment of the prosthesis: this is usually a late complication; this term indicates a progressive detachment of the components of the prosthesis from the bone, and it is not a consequence of infection. If it is very extended, it may lead to a re-implant of a new prosthesis. For yet unknown reasons, such complication appears to be statistically more frequent among younger patients. Peri-prosthetic ossifications: they develop (for unknown reasons) during the first few months after the operation and lead to a partial loss of the joint's range of motion.