Unlike its predecessors, includes an integrated optical camera that allows the robot to acquire images in real time and perform a volumetric evaluation of the surgical field to auto-detect its location and avoid collisions with other system components.

WHAT SURGERIES IS IT USED FOR?

• Surgery to correct scoliosis
• Arthrodesis of the dorsal spine (degenerative, traumatic or tumor pathology)
• Arthrodesis of the lumbar spine (degenerative, traumatic or tumor pathology)
• Vertebral interbody fusion
• Vertebral biopsy (tumor pathology)
• Kyphoplasty (vertebal fractures)

WHAT ARE THE BENEFITS FOR THE PATIENT?

Robotic surgery systems have shown obvious advantages in comparison with conventional surgery of the spine:

• Improved precision in the placement of implants. Recent studies have confirmed that the system has a 98.7% precision rate of correct placement of screws (without deviation).
• Minimizes exposure to ionizing radiation, both for the patient and for all the operating room personnel. The average time required to insert a screw is 3.6 minutes, which reduces both the duration of the surgery and the risk of infection, as well as reduced exposure to radiation.
• Facilitates minimally invasive surgeries, which means a smaller surgical incision, and reduced loss of blood.
• Reduced postoperative pain thanks to the use of the robotic arm that less muscle retraction needed to operate in deep tissue.
• Contributes to a lower risk of infection thanks to a shorter time in surgery.
• Reduced risk of infection in the adjacent segment according to recent studies.

HOW DOES IT WORK?

The Mazor X robotic surgery system works as follows:

• The surgeon plans the surgical path of the implants using the patient’s images (CT scan taken before or during surgery) at the Mazor X Stealth Edition work station.
• The patient is placed on the operating table.
• The robot is anchored to the table and to the patient.
• The robotic arm records images of the patient. Mazor X features an innovative cross-modality image recording process, each vertebral body is independently registered. The robotic guidance system analyzes and pairs images from different modalities, such as matching a preoperative CT scan with intraoperative fluoroscopy or 3D surgical images, including images captured at different times and in different anatomical planes.
• The software guides the robotic arm according the the plan established by the surgeon for the surgical field.
• Placement of implants by the surgeon aided by the real-time neuronavigation system and guided by the robotic arm.

Extreme Lateral Interbody Fusion (XLIF) is a recently available, innovative technique for lumbar fusion surgery, that makes it possible access the spinal column using a lateral path through the outermost part of the abdomen. Once the spine has been reached, with this technique, it is possible to manipulate the discs and vertebrae while avoiding damage to the nerves and muscles.

Since its introduction, this technique has been widely used in the United States, and gradually extended through Europe, where we pioneered its use when Dr. Francesco Caiazzo was the first surgeon to use it in Spain, in 2014, with the XLIF Nuvasive system.

The procedure consists of a transpsoas retroperitoneal approach that gives direct access to the intervertebral disc from an antero-lateral view, allowing almost complete replacement of the disc and correction of the sagittal plane. It allows the entire lumbar spine to be accessed up to the 5th lumbar vertebra (L5, except the lumbosacral transition L5-S1), and the thoracic spine up to the 4th thoracic vertebra (T4).

WHICH CASES IS IT USED FOR?

This technique is used to perform intervertebral arthrodesis or fusion [enlace a fusión] and is used especially when dealing with degenerative pathologies of the spinal column, such as:

• Degenerative disc disease (DDD).
• Spinal stenosis and foraminal stenosis.
• Spondylolisthesis (vertebral displacements), both from degenerative disease and from other causes (injury, congenital, acquired, etc.).
• Surgical repair of failed prior surgeries.
• Pathology in the adjacent segment.
• Deformities: adult degenerative scoliosis, FBSS-failed back surgery syndrome and alterations of sagittal balance.

When the segments affected by the pathology are between the 4th thoracic vertebra (T4) and the 5th lumbar vertebra (L5), except the L5-S1 space, this approach is also used to perform arthrodesis of thoracic segments, up to T4, and to treat thoracic disc herniations and thoracic-lumbar vertebral fractures.

WHAT DOES THE PROCEDURE CONSIST OF?

The technique consists of two parts: first, the approach, and second, the arthrodesis itself.

Approach

With the patient lying on one side, the surgeon makes a lateral incision, usually horizontally, to access the muscles of the abdominal wall. Next, the muscle fibers are separated (without cutting them) from the external oblique, internal oblique and transverse muscles of the abdomen. Once past the transverse muscle of the abdomen, the retroperitoneal space is accessed, where the psoas muscle is identified. Using specific instruments, we pass through this muscle, performing neurophysiological mapping to identify the nerves in the muscle so as not to harm them. A separator is then placed that allows us to access the intervertebral disc.

Arthrodesis

The diseased intervertebral disc is cut out. Usually, this access is used for the upper lumbar segments up to L4-L5, except for the L5-S1 space. Once the disc is completely removed, the vertebral endplates are cleaned, removing the cartilage, so that the arthrodesis material can more easily contact and fuse with the bone of the vertebra. Once the disc space has been prepared, the interbody fusion cage, or “spine cage” can be placed (it can be made of a variety of materials such as titanium, porous titanium or PEEK- Polyetheretherketone, titanium-coated PEEK, NanoMetalene etc..).

These materials have the characteristics of driving the fusion, that is to say, they guide the formation of the bone callus between the two vertebrae. Usually, to facilitate the formation of this callus, the “cages” are filled with a material referred to as bone wax, which may be of various origins. These are biological materials, which, in addition to helping and guiding the formation of the callus, they generate and stimulate formation of bone. After the fusion takes place, the surgery is usually completed with the placement of posterior screws that will be implanted in a minimally invasive percutaneous way, to give greater stability to the fused vertebrae.

ADVANTAGES OF EXTREME LATERAL INTERBODY FUSION (XLIF)

Minimally aggressive approach
Minimally aggressive towards functional structures thanks to the minimally invasive percutaneous approach.

Recovery
Less pain and faster recovery: the surgical access is made using a retroperitoneal approach, cutting no muscles and with no aggression to the patient’s bone.

Reduced hospital stay
Reduced hospital stay: in the absence of any complications the blood loss is minimal compared to a classic posterior approach.

Better results
The interbody cages used in this procedure, are larger and wider than any others, so they allow bicortical support and they occupy a larger area of contact between the vertebrae. This, in turn, means that they offer a much more powerful biomechanical support than any other prosthesis, and above all, better fusion and stability results compared to PLIF (posterior lumbar interbody fusion) and TLIF (transforaminal lumbar interbody fusion), which are techniques for disc stabilization using a posterior approach. This improves the stability of the patient’s spine.

TLIF                                                               PLIF                                                 XLIF

(photo source: Nuvasive)

THE PATIENT CAN RETURN TO WORK AND NORMAL DAILY ACTIVITIES SOONER

The cage used in a lateral approach gives a much wider area of surface contact between the vertebrae than a cage placed by any other surgical approaches. It has been shown that in order to create a good fusion environment between two vertebrae, and allow them to fuse to each other, the interbody cages should cover at least 30% of the surface of the vertebrae (the so-called vertebral endplate); prostheses inserted by the XLIF route sometimes cover more than 50% of the usable fusion surface between 2 vertebrae. If complemented with posterior screws, the interbody fusion has a higher percentage of fusion compared to all other techniques, both anterior and posterior.

MAINTAIN THE PATIENT’S SAGITTAL BALANCE

The XLIF system, offers cages of different angles and lordosis (0, 10, 20, 30 degrees). It is scientifically proven that the placement of hyperlordotic interbody cages using the ACR (Anterior Column Realignment) technique is effective in surgery to correct deformities and allows the patient’s sagittal balance to be conserved, unlike complex vertebral osteotomy surgeries that require long surgical times, entail considerable blood loss, have high rates of complications and high hospital readmission rates.

RATE OF COMPLICATIONS

The rate of complications is very low: the technique is used by specialized surgeons and can be used to treat multiple pathologies.

INDIRECT DECOMPRESSION

Makes it possible to perform indirect decompression of the central spinal cord, and of the vertebral foramina in many cases. In this way we avoid performing a direct decompression which is performed following aggression and decompression of the posterior musculature, and resection of the patient’s posterior bone elements.

RECOVERY AND REHABILITATION

Following surgery, the patient is transferred to a hospital room, and the next day will already be able to begin moving about, and even walk. A follow-up EOS x-ray is taken, and on the fourth day after surgery, the patient is usually discharged.

Next, about 7 to 10 days after the operation, the patient will see a member of the nursing staff at Instituto Clavel to check how the surgical wound closure is healing. The patient may need to wear an elastic support during the first weeks after surgery.

Approximately 4 to 6 weeks after the surgery, the patient will return to the clinic for a visit with the surgeon. The patient should also have periodic follow-up x-rays taken at 3, 6, 9, and 12 months from the date of the surgery, to track how the fusion is progressing.

Depending on how the recovery is progressing, in about 3 to 6 months from the date of the surgery, the patient can gradually return to normal activities, including some specific physical activity (elliptical or stationary bike, swimming, walking on a treadmill, cardio exercise, stretching, Pilates and yoga) under the supervision and guidance of physiotherapists, like those of FisioSpine.

RISKS OF THE SURGERY

The risks and possible complications can be related to either the approach, or the arthrodesis. With respect to the approach, there may be the typical risks associated with any surgery:

• Hemorrhage
• Hematoma
• Superficial and/or deep infection

More specifically, in this surgery there is the risk of lesion to the muscle of the abdominal wall, which can cause a lump to appear in the abdominal wall. Passing through the psoas muscle may weaken the muscle, which causes discomfort in the form of pain or tingling when the hip is flexed. Usually, this discomfort is temporary (< 4 weeks) disappearing spontaneously or with the help of medication.

Rarely, in less than 1% of cases, the lumbar nerve plexus may be damaged, provoking damage in the nerve that weakens leg strength. Extremely rare, (<1%) are lesions to organs or abdominal blood vessels (veins or arteries).

With respect to the arthrodesis, we may find the following risks:

• Failure of the vertebrae to fuse (pseudoarthrosis, or non-union) which leads to recurrence of the same pain as before the surgery <5%.
• The fusion cage moves or sinks into the vertebral body < 5%
• Fracture of the vertebral endplates <1%.

If any of these circumstances arise, a new surgery may be necessary. Due to the distraction between the treated vertebrae, that is, the recovery of the disc height after implant placement, radiculopathy may appear in the postoperative period (<5%), which is usually transient and may require short-term medical treatment.

WHAT CASES IS IT USED FOR?

Endoscopic surgery of the lumbar spine is indicated for certain pathologies:

• Foraminal disc herniation
• Extraforaminal disc herniation
• Posterolateral or medial disc herniation
• Foraminal stenosis
• Central canal stenosis

On the other hand, this type of intervention is not recommended in case of bulky or migrated hernias, calcified, or with spondylolisthesis.

WHAT DOES THE PROCEDURE INVOLVE?

Lumbar endoscopic discectomy is performed through a 5-8 mm incision in the skin. Through the incision, a cannula is inserted until reaching the vertebral disc through the neural foramen (in the case of foraminal or extraforaminal hernias) or the interlaminar space (posterolateral or medial hernias), depending on the location of the hernia to be treated.

Through this same cannula, first the optical camera that allows the surgeon to view the enlarged field of work on a screen is introduced, and then, the instruments that will be used to extract the herniated disc tissue and decompress the nerve. The delicate internal tissues are constantly irrigated through the cannula throughout the surgery, which makes it possible to control or stop bleeding and dissection of the structures.

Several studies have shown that endoscopic spine surgery has the following advantages when compared to conventional surgery:

• Less postoperative pain thanks to the lesser manipulation of tissues.
• Less blood loss.
• Lower risk of cerebrospinal fluid (CSF) fistula.
• Causes no instability, as in many cases it is not necessary to remove any bone to reach the hernia.
• Procedure is performed under local anesthesia and sedation, eliminating risks associated with general anesthesia.
• Enables a swift return to work.

RECOVERY AND REHABILITATION AFTER AN ENDOSCOPIC LUMBAR SURGERY

As it is a minimally invasive surgery, the recovery is faster when compared to traditional surgeries. The patients can get up and walk the same day of the operation, and in a large percentage of cases, they need only 1 night in the hospital.

The average recovery time is 3-6 weeks. Rehabilitation and physiotherapy are not required because there has been little manipulation of the tissues and bones during the procedure, so postoperative pain is significantly reduced.

RISKS

The possible risks and complications of endoscopic surgery are similar to those of conventional surgery. We review them below:

Immediate
Damage to neurovascular elements or to the abdominal-pelvic structures, insufficient decompression.

Short term
Dysesthesia, hematoma, infection, CSF fistula.

Long term
Reherniation or instability at the operated level.

WHAT IS ADR SURGERY?

ADR surgery is a surgical procedure in which a degenerated intervertebral disc is removed and replaced with an artificial implant that mimics the function of a natural healthy disc. This procedure is used for patients suffering chronic pain due to degenerative cervical or lumbar disc disease, who have not found relief through conservative treatments.

At Instituto Clavel, we are pioneers in ADR, using the technique of anterior approach to the spine for the placement of the artificial disc. Thanks to this minimally invasive technique, we are able to avoid opening the back muscles, which in turn reduces postoperative pain and helps the patient achieve a faster and better recovery.

RESULTS OF THE SURGICAL TECHNIQUE

At Instituto Clavel we have more than 20 years of experience, having performed more than 1,500 successful ADR surgeries. This experience ensures that we can perform this type of operation safely and obtain the best results for our patients.

We have found that this technique is effective in significantly reducing pain in 90% of cases, resulting in a direct increase in your quality of life. In addition, approximately 70% of patients have been able to make a complete return to playing sports, a rate unheard of for other spinal surgeries.

WHAT DOES ADR SURGERY CONSIST OF?

Through experience and advances in innovation in recent years, the procedure for disc replacement surgery has improved markedly, making it the best option for those patients with lumbar and cervical disc degeneration.

The prostheses that are used today are highly resistant to wear and have a biomechanical behavior very similar to that of the natural disc. This means safer surgeries with better clinical results. Find out more about the types of surgery and the surgical process below.

TYPES OF ADR

Disc nucleus replacement

Replacement of the disc nucleus is not possible in the case of cervical discs due to their size and based on complications and the clinical results observed in the various studies that have been carried out over the years.

In the late 90’s and in the first decade of the 2000s, various proposals and designs of artificial lumbar disc nucleus implants were released.

In 2007, some of the doctors at Instituto Clavel participated in a multicenter study called Custom Implantable Medical Devices along with several European technology centers. We thought that if we were able to design a customizable disc nucleus prosthesis, there would be fewer cases of extrusion and subsidence, which are problems inherent in this type of prosthesis.

To do this, we searched for what could be the best possible material: a polyurethane with characteristics very similar to the lumbar disc. However, there turned out to be several difficulties when it came to implant it, and undoubtedly there would have been other complications due to the fact that the nucleus is not the only source of pain.

For this reason, and despite the attractiveness of the idea of replacing only the disc nucleus, at Instituto Clavel we believe that the recommended surgery in cases of lumbar and cervical degenerative disc disease is the total (or almost total) replacement of the disc.

Total disc replacement

With the total or almost total replacement of the disc we achieve the elimination of all the pain-causing agents: the degenerated nucleus, the degenerated and fissured ring, the synovertebral nerve endings and the degenerated endplate.

When this is done, the clinical result is usually very satisfactory, with good long term results in greater than 95% of cases. In addition, we are able to conserve the joint mobility.

Despite the fact that many surgeons continue to consider arthrodesis or spinal fusion as the surgery of choice, at Instituto Clavel we consider that ADR is the best option in cases of disc degeneration due to the advantages it presents and given the improvement in designs and materials that have taken place in recent years.

SURGICAL PROCEDURE

If you are considering ADR surgery as one of the treatment options to solve the problem of disc degeneration, you probably have many questions about the surgical procedure. So to answer your questions, in the following paragraphs we give you a detailed description of the steps involved in the operation.

At Instituto Clavel, in addition, we have the Preparation, Empowerment, and Recovery (PER) program for patients which will help you throughout the process, from getting prepared for the surgery and on through your postoperative recovery.

BEFORE THE SURGERY

Lumbar or cervical ADR surgery, like all surgeries, involves a detailed assessment of each case prior to the surgery. To have this done, patients should contact the Instituto Clavel to make an appointment at which they will be able to provide the specialist with all the necessary information.

In approximately one week after we have all your necessary information, you will receive the complete evaluation of your case from the specialist. In some cases, the doctor may tell you that some additional tests are needed before surgery. From this moment on, the preoperative preparation steps included in our PER program will be activated, which include specific protocols to reduce stress and make this stage of the process easier.

In the event that the patient has previously undergone any treatment (surgical or non-surgical) to treat the pain caused by the disc degeneration problem, it is important that you tell us so that the surgeon takes it into account before the intervention. Also, it is essential that you know your medical history and inform us of any medical conditions and any treatment that you are currently following.

DURING THE SURGERY

When the scheduled date for the operation arrives, the protocols of our PER program for surgery are activated, which aim to facilitate this stage of the process.

The patient is admitted to the hospital on the day of the operation. They will need to abstain from eating or drinking anything for at least 6 hours prior to the scheduled surgery time. While waiting for the operation, the patient will be in a hospital room, where he can be accompanied by his family and friends.

After this, he will be taken to the surgical area where the anesthetist will ask him some questions and then he will be asked to sign an informed consent of the possible risks related to anesthesia.

Next, the operation, which usually lasts about an hour, will be performed by the spine surgeon at the lumbar or cervical level. Although it depends on each case, as a guideline, when the operation involves more than one level, each extra level takes about fifteen minutes more.

When the surgery is over, the patient is awakened in the operating room and transferred to a recovery area, where he is monitored for about two hours before being taken to his hospital room.

The discharge from the hospital will depend on each patient’s case. On the average, the patient stays for one day for cervical arthroplasty, and three days for lumbar arthroplasty.

It is totally normal for the patient to feel discomfort in the area of the surgical incision or in the cervical or lumbar area, but this will subside over the next few days.

PATIENT POST-OPERATIVE AND RECOVERY PHASE

Recovery from ADR surgery, whether cervical or lumbar, is a gradual process, and it is normal for the patient to notice some discomfort. During the first week after surgery, we recommend that the patient take short walks, and exert no effort that causes stress. A follow-up visit is scheduled for the patient between 7 and 10 days after surgery. At this appointment the surgical wound is inspected, and the suture strips are removed, since no external stitches are applied in ADR surgery.

After that point, as a general recommendation, the patient should not exert any stressful effort or adopt bad postures during the first three months after surgery, and especially during the first month. They will be able to start swimming one month after surgery and run or ride a bicycle after the first 3 months.

After about 3 weeks, the patient can return to work if it does not require physical effort. For patients whose professional activity requires physical exertion, they can usually return to work about 6 weeks after the operation. In addition, we recommend that the patient have supervised rehabilitation sessions in a specialized physical therapy center.

Apart from the general recommendations, there are specific indications depending on whether the intervention was lumbar or cervical. At Instituto Clavel we do not recommend the use of lumbar belts on a routine basis. They are only indicated in some cases, for a short period of time, when the patient notices a certain abdominal distension.

On the other hand, we do recommend that patients who undergo cervical ADR wear a soft cervical collar – provided in the hospital, which can be removed for eating and sleeping – until the day of removal of the suture strips.

Of course, the recovery steps recommended will depend on each patient and will be made in a totally personalized way in each case. At Instituto Clavel we accompany the patient throughout the process. In addition, the staff continues to be available so that the patient can ask any questions about recovery through the usual channels such as telephone or email.

CONTROL OF POST-OPERATIVE PAIN

Postoperative discomfort or pain is normal, but at Instituto Clavel we do our best to ensure that this phase is as easy as possible for the patient.

During the hospital stay, the patient will receive painkillers intravenously to alleviate this post-operative discomfort.

Upon discharge, oral medication will be prescribed by the doctor according to each case. This will be gradually withdrawn on advice of the doctor at the following visits to Instituto Clavel.

The medication prescribed during and after hospital admission sufficiently covers the pain management needs of both cervical and lumbar ADR surgery.

REHABILITATION EXERCISES

After an ADR operation, the patient will need to perform a series of prescribed postoperative recovery exercises.

ARTIFICIAL DISCS

The artificial discs we use are elastomeric ones, all of them third generation. This means that the core is made of an elastomeric material (specifically, polyurethane) that mimics the mechanics of the natural disc in the best possible way. We use the cervical or lumbar M6 disc and the cervical or lumbar ESP disc, the former being less constrained than the latter. The model of implant chosen is based on the anatomy and mechanical requirements of the patient’s spine.

WHO IS A CANDIDATE FOR ADR SURGERY?

In general, the vast majority of patients with disc degeneration problems are candidates for ADR surgery. Also, in the case of athletes, it usually allows them to return to full activity and even competition within an estimated period of three months. In fact, at Instituto Clavel we are pleased to have seen how up to 70% of the patients operated on for lumbar ADR return to sports activity.

SIDE-EFFECTS OF THE SURGERY

ADR surgery has very few side-effects. Below are a few that we have seen over our 20 years of experience:

• In some cases, we have seen patients who have had residual pain or new low back pain that can be attributed to some biomechanical stress on the inter-pituitary joints, also known as facets. These cases improve with infiltrations or with radiofrequency treatments.
• We have observed a very few cases of the lumbar disc prosthesis sinking, especially in menopausal women over the age of 50. That’s why, in the case of women, for all patients over 40 or 50, we request a bone densitometry test prior to surgery to know the quality of their vertebrae.
• There have been some cases of extrusion or anterior displacement of the implant, all of them solved by reoperating and repositioning of the implant.
• We inform our male patients prior to surgery that there is a 0.5% risk of retrograde ejaculation, especially when the L5-S1 disc is operated on. However, in most cases it is resolved.

В клинической больнице Барселоны / Hospital Clínic de Barcelona впервые в Испании была проведена операция по замене тазобедренного сустава без госпитализации. В последние годы время нахождения в больнице сократилось вдвое (с 7 до 3,5 дней), тем не менее, подобные операции обычно требуют обязательной госпитализации пациента. Благодаря высокой квалификации врачей удалось избежать необходимости оставлять пациента в клинике.
Операцию проводил доктор службы ортопедической хирургии и травматологии Хенаро Фернандес-Валенсия / Dr. Jenaro Fernández-Valencia, являющийся заведующим отделением тазобедренного сустава больниц Hospital Clínic de Barcelona и Barnaclínic +. Операция состоялась более 2 месяцев назад (7 июля), и за прошедшее время никаких осложнений не наблюдалось.

«Пациент, перенесший замену тазобедренного сустава, смог отправиться домой сразу после операции, в тот же день. Эта процедура называется амбулаторной заменой тазобедренного сустава или заменой тазобедренного сустава без госпитализации», – рассказал доктор Фернандес-Валенсия.

ОПЕРАЦИЯ ПО ЗАМЕНЕ ТАЗОБЕДРЕННОГО СУСТАВА БЕЗ ГОСПИТАЛИЗАЦИИ: БЕЗОПАСНОСТЬ И ОТЛИЧНЫЕ РЕЗУЛЬТАТЫ

В Испании операции по замене тазобедренного сустава без госпитализации была выполнена впервые, но безопасность и эффективность этой техники подтверждает опыт ее успешного применения в других европейских странах и многочисленные научные исследования. Однако очень важно, чтобы у пациента не было противопоказаний для этой процедуры. Идеальными кандидатами на операцию по замене тазобедренного сустава без госпитализации являются молодые люди без серьезных заболеваний, в этом случае обеспечивается максимально высокий результат.

СКОЛЬКО ДЛИТСЯ ГОСПИТАЛИЗАЦИЯ?

После традиционной операции по замене тазобедренного сустава пациентам позволяют покинуть клинику в соответствии с критериями функциональной выписки. Другими словами, учитываются контролируемая боль, легкая боль при ходьбе, способность преодолеть дистанцию около 50 метров, подниматься и спускаться по лестнице и т.д.

После операции по замене тазобедренного сустава без госпитализации следует придерживаться той же стратегии с соблюдением требований функциональной выписки. Таким образом, если у пациента проявляется неуверенность, выраженная боль или другие отклонения от указанных критериев, госпитализацию придется продлить до тех пор, пока состояние пациента не будет отвечать необходимым для выписки нормам.

По словам доктора Хенаро Фернандес-Валенсия, «замена тазобедренного сустава без госпитализации представляет собой смену парадигмы в послеоперационном ведении аутопластики тазобедренного сустава, поэтому возможность выписки пациента в день операции – еще один шаг в эволюции нашей программы быстрого восстановления после этой серьезной операции».

КАК ДОСТИГАЕСЯ СНИЖЕНИЕ ВРЕМЯ ГОСПИТАЛИЗАЦИИ ПРИ ХИРУРГИИ ПРОТЕЗА БЕДРА?

1. Обучение пациентов

Перед операцией по замене тазобедренного сустава пациент участвует в семинаре, чтобы получить больше информации о своей патологии, процессе госпитализации, операции по замене протеза бедра, функциональном восстановлении и о том, какие меры следует предпринять для более быстрого восстановления.

2. Минимизация риска переливания крови

Чтобы избежать возможных анемий, которые могут увеличить риск переливания крови, проводится предварительное обследование пациента, а во время самой операции вводится транексамовая кислота. Благодаря этим мерам, количество случаев переливаний крови постепенно сокращается (30% в 2013 году и 2% на сегодняшний день).

3. Менее инвазивная хирургия

Отделение ортопедической хирургии и травматологии клиники El Clínic, возглавляемое доктором Пере Торнером, имеет команду, специализирующуюся на планировании и выполнении минимально инвазивных операций по замене тазобедренного сустава. С 2016 года команда доктора Фернандеса-Валенсия занимается заменой тазобедренного сустава методом прямого переднего доступа. Этот вид процедуры позволяет имплантировать протез, не разрезая мышцы или сухожилия, а значит, добиться быстрого восстановления.

4. Улучшение состояния пациента и уменьшение послеоперационной боли

Сведение к минимуму использования производных морфина и однократная доза кортикостероидов в начале операции по замене тазобедренного сустава уменьшает боль, тошноту и головокружение при вставании.

5. Ранняя мобилизация

Для быстрого восстановления после операции по замене тазобедренного сустава очень важно, чтобы пациент начал двигаться, как можно скорее. Это ключ к улучшению контроля боли, мышц и венозного возврата.

В ЧЕМ СОСТОИТ ОПЕРАЦИЯ ПО ЗАМЕНЕ ТАЗОБЕДРЕННОГО СУСТАВА?

Полная замена тазобедренного сустава (тотальная артропластика) направлена ​​на замену поврежденного тазобедренного сустава. Ухудшение состояния может быть вызвано остеоартритом, последствиями травмы, запущенными заболеваниями, такими как дисплазия или некроз сосудов головки бедренной кости. Операция по замене тазобедренного сустава обычно занимает около полутора часов и состоит в замене суставной поверхности вертлужной впадины на вертлужный компонент (чашку).

В данную чашку устанавливается суставная головка, связанная со штифтом, который имплантируется в костномозговой канал бедренной кости, прочно фиксируется там и заменяет изношенную головку.

Было доказано, что ежедневное вдыхание загрязненных частиц, очень тесно связано с высоким риском развития остеопороза, снижением плотности кости. Такое влияние возможно из-за окислительных процессов и воспалений.