HIP ENDOPROSTHESIS IMPLANTATION AND COMPARISON OF REHABILITATION OUTCOMES PERFORMED WITH AND WITHOUT PHYSIOTHERAPIST SUPERVISION

Zglob kuka je jedan od najvećih zglobova u ljudskom tijelu. Sastoji se od glave bedrene kosti te acetabuluma na zdjelici. Prilikom pokretanja tijela i održavanja ravnoteže, zglob kuka služi kao potpora cijelom tijelu. Ako zbog loše biomehanike, starosti, inaktiviteta ili ozljede dođe do oštećenja zglobne hrskavice, dolazi također do degenerativnih promjena u samom zglobu. Jedna od najčešćih degenerativnih promjena u zglobu kuka je osteoartritis. Osteoartritis oštećuje zglobnu hrskavicu te posljedično dolazi do pojave boli i smanjene funkcije zgloba. Ako simptomi utječu na kvalitetu života, a konzervativna terapija nije dovela do smanjenja simptoma, bolesnik se podvrgava operaciji, odnosno ugradnji endoproteze. Postoje više vrsta endoproteze. Po broju dijelova postoje djelomične (parcijalne) te potpune (totalne). Djelomične zamjenjuju jedno zglobno tijelo, a potpune oba. Također, proteze mogu biti monolitne, odnosno izrađene iz jednog dijela te modularne izrađene od više dijelova koji se sklapaju tijekom operacije. Prema načinu fiksacije postoje cementne, bescementne i hibridne. Uz sve nabrojane, postoje još i revizijske i tumorske endoproteze. Za ugradnju endoproteze, postoje više operativnih pristupa zglobu. U prošlosti su operativni zahvati bili veći i složeniji, što je posljedično dovodilo do dužeg oporavka bolesnika. Danas se sve više provode minimalno invazivni zahvati koje maksimalno smanjuju oštećenja okolnih mekih tkiva. Rehabilitacija se može provesti u rehabilitacijskom centru, ali novija istraživanja prikazuju da ako nema komplikacija, vježbanje u vlastitom domu po programu bez nadzora fizioterapeuta ima slične ishode rehabilitacije.The hip joint is one of the largest joints in the human body. It consists of the head of the femur and the acetabulum on the pelvis. During the movement of the body and maintaining balance, the hip joint serves as support for the whole body. If, due to poor biomechanics, age, inactivity or injury, joint cartilage is damaged and occur degenerative changes in the joint. One of the most common degenerative changes in the hip joint is osteoarthritis. Osteoarthritis damages the articular cartilage and consequently causes pain and reduce joint function. If the symptoms affect the quality of life and conservative therapy has not led to a reduction in symptoms, the patient undergoes surgery or total hip arthroplasty. There are several types of endoprostheses. According to the number of parts, there are partial and complete (total) endoprotheses. Partial ones replace one articular body and complete replace both. Also, prostheses can be monolithic, made of one part and modular, made of several parts that are assembled during the operation. According to the method of fixation, there are cement, cementless and hybrid endoprotheses. In addition to all of the above, there are also revision and tumor endoprostheses. For endoprosthesis implantation, there are multiple surgical approaches to the joint. In the past, surgical procedures were larger and more complex, which in turn led to a longer recovery of patients. Today, minimally invasive procedures are being performed that minimize damage to the surrounding soft tissues. Rehabilitation can be performed in a rehabilitation center, but recent research shows that if there are no complications, exercising in your own home according to a program without the supervision of a physiotherapist has similar rehabilitation outcomes