Responsible approach to surgery endoprosthesis, many patients are trying to find information about the types and brands of prostheses, manufacturers and modern models of endoprostheses. Indeed, with the development of the Internet, it would seem that you can find the answer to any question.

Often, during consultations, operating surgeons hear statements from patients:
- "cement prosthesis is bad, the best cementless"
- “I read (read) that the best prosthesis is ceramic”
— “good prostheses are made in Germany (Great Britain, USA)”

If everything was so simple, then “the best German cementless ceramic prosthesis” would have appeared long ago, and all the rest would have been discontinued.

What are prostheses?

Speaking in dry facts, endoprostheses are:

— fixation type: cement, cementless and hybrid;
— by operation type: total and semi-prostheses;
— hinge type: related and unrelated;
— by type of material: ceramic, polymer, metal and mixed.

What does this information give us as patients?

To be honest, it does nothing.
The main thing we need to know is that The best prosthesis does not exist!

There are many dentures. Some of them are better at one thing, some are better at something else.
On one condition! If we are talking about manufacturers with a worldwide reputation.

Unfortunately, this cannot be said about domestic endoprostheses.
Our technologies and a number of other, sometimes insurmountable factors, do not leave the orthopedic traumatologist any choice between domestic and foreign manufacturers.

If you or your loved ones need medical assistance, please contact us. The specialists of the site will advise the clinic where you can receive effective treatment:

Which endoprosthesis manufacturer is the best?

You need to trust manufacturers with a worldwide reputation, having their own history, production and scientific bases and leading in the world in terms of sales.

There are currently six such companies:

1. Zimmer (Zimmer, international company)
2. DePuy (DePew, an international company, is owned by Johnson & Johnson, Johnson & Johnson)
3. Stryker (Stryker, international company)
4. Smith & Nephew (Smith & Nephew, international company)
5. Biomet (Biomet, international company)
6. Aesculap, B. Braun (Aesculap Bee Brown, international company)

Each of these companies is international and it is impossible to tell which one is German or American.

The most important

Regardless of which prosthesis is chosen, it is much more important how well the operation will be performed.
Incorrect installation will not save the “best endoprosthesis”, and a correctly installed “average endoprosthesis” will surely last for many decades.

Based on this, no matter how trite it may sound, the main thing is the hands of the surgeon.
A worthy traumatologist-surgeon will choose the necessary prosthesis for you or offer an alternative where it is possible.

Therefore, it is more reasonable to look for a good specialist than to spend time looking for the “best prosthesis”.
Naturally, the question arises: “How to find this very good surgeon?”

As a rule, the surgeon who operates a lot operates well. Thanks to the system of providing high-tech medical care, there are many such surgeons in our country. We now have many 30-year-old surgeons who perform 3-5 operations a day, accumulating several hundred operations a year. This is a lot even by world standards and commands the respect of foreign doctors: the world is considered an experienced surgeon who performs more than 50 operations a year. We have something to be proud of!

There is another subtle and important point.

No matter how brilliantly the operation was performed, much depends on the correct actions during the recovery and rehabilitation of the patient. It's no secret that many doctors don't like answering questions. There are many questions after the operation. When can you drive? How long will the temperature stay? When can I go to the bath? Why is my leg swollen? Of course, you can find answers on the Internet, but only an experienced orthopedic surgeon can answer them as accurately as possible.

Summing up: The main thing is not the search for the “best joint”, but the choice of a really worthy specialist who will select the necessary prosthesis and successfully perform the operation.

Take care of yourself!

Hip arthroplasty is often the only method for restoring motor activity. The installation of the implant eliminates the pain syndrome that does not leave the patient with diseases of the musculoskeletal system.

Modern types of prostheses are designed to completely imitate the native joint and fulfill its functional abilities.

From a large number of endoprostheses, you can choose a suitable implant. Sometimes patients try to choose an implant on their own, study brands, models, varieties. Orthopedists often hear the following from patients:

• Recently I read (-la) that the most reliable prosthesis is made of ceramics.
• A cemented denture is an obsolete model, while a cementless denture is a good option.
• The best prostheses are foreign, they have positive reviews.

The first myth that should be dispelled is that there is no best endoprosthesis.

The second is that there are many variations of orthopedic constructions for replacing hips: some of them are better, others are inferior in one way, but superior in another. We are talking about well-known companies operating in the orthopedics market for more than a year.

There are inexpensive models, but there are also expensive prostheses. This does not mean that the cheaper option can be much worse and provoke complications. When releasing a new implant model, the company is forced to raise its cost, since development, production, and consumables require large investments. New models will take into account the shortcomings of the previous ones and will no longer contain them. It is possible that the service life will be longer.

In the third case, it is necessary to take into account not only the quality of the prosthesis, but also the work of the surgeon. Even an expensive implant does not guarantee the success of the operation with a low qualification of the doctor and no experience in arthroplasty. Therefore, it is worth focusing not only on models and firms, but also on the knowledge of the one who will operate on you. Don't forget the importance of rehabilitation. A full recovery course will guarantee a successful recovery with any type of prosthetic design.

Models of leading foreign firms do not have any particular differences, so it is difficult to say which one is better. Comparison - rather by the standards of price-quality. Well-known firms Zimmer, De-Puy, Biomet produce equivalent samples that do not have pronounced differences.

When choosing a prosthesis, look not at the company or cost, but at a more important feature that affects the life of the adaptation - a friction pair.

Types of endoprostheses, their differences

If we talk about the appearance of the prosthesis, it is a complete imitation of a person's native joint, which can withstand everyday stress and has the same functional abilities as the previously destroyed one.

Features and differences are distinguished by the type of arthroplasty:

• superficial. The head of the hip joint and the acetabulum are replaced;
• total. Complete replacement of damaged bone and cartilage with excision of the femoral neck.

Implants are distinguished by the method of attachment:

• Fixation without medical cement. It is used for young patients without signs of osteoporosis. With good bone density, they grow into the prosthesis and secure it. With cementless fixation, a stem having a titanium alloy can be used.
• Fastening with cement. The technique is used in the elderly or in patients whose bone density does not allow the use of a cementless method.

Recently, you can often hear the concept of "liquid implant". It is not related to full-fledged endoprosthetics, since it is not a prosthesis. It is supposed to introduce certain types of acids, the purpose of which is to restore the connective tissue of the cartilage. Any expert will tell you that this is impossible. Under the influence of the degenerative-dystrophic process, pathologies, the joint is completely destroyed and does not have the ability to regenerate. The only way out is surgery.

Consider friction pairs. It makes no sense to choose a particular brand or focus on price, but it makes sense to consider other characteristics, because wear products will negatively affect the surrounding soft tissues and bones. Here's what you really need to discuss with your doctor.

There are the following varieties:

• metal combined with metal;
• metal and polyethylene;
• ceramics plus ceramics;
• combination of ceramics and polyethylene.

Each type has its own advantages and disadvantages. It cannot be said that the combination of some components will be bad, and the other - good. The prosthesis, as well as friction pairs, are selected individually. What is not suitable for one patient may be recommended for another.

A popular option - a combination of a metal component with a metal one due to its low price, however, is not recommended for installation for everyone - it has a number of limitations. It is more often implanted in men who are accustomed to a more active lifestyle. It is strongly not recommended for women planning future pregnancy: there is a high risk of penetration of toxic products into the placenta, which negatively affects the fetus. In a number of countries, the use of such a combination of components is prohibited.

More often used ceramics in combination with polyethylene: suitable for patients of any category, has no age restrictions. Revision replacement intervention may be needed after 15-20 years.

From 10 to 15% of complications after arthroplasty are associated with incorrect selection of the prosthesis, and more specifically, friction pairs. That is why it is important to find a qualified orthopedist and pay attention not to the brand of the implant, but to its quality.

The highest service life of the friction pair "ceramics plus ceramics". Suitable for almost all patients, the only contraindication is that such prostheses for osteoporosis (low tissue density) are not implanted. The main condition that allows you to extend the duration of use, reduce the risk of reoperation is the correct installation of the structural components.

Hip joint: prosthesis price

The cost of endoprosthetics and the implant itself depends on the medical center of orthopedic surgery. The average price in Moscow according to 2014 statistics is 90,000-120,000 rubles. This price did not include hospital stay and diagnostic tests.

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The price of orthopedic structures depends on the manufacturer and the material used. Foreign companies offer implants in the region of 1300-2000 dollars, domestic ones are several times cheaper.

The quality of arthroplasty is not affected by the cost, but by the quality of the operation and subsequent rehabilitation. Even the most expensive endoprosthesis does not guarantee a therapeutic effect if the intervention is performed incorrectly and there is no correct recovery period.

Where to buy a hip prosthesis?

You will deal with the purchase of an implant to replace the hip joint directly with your doctor. It is they who cooperate with manufacturers and will be able to say how much a certain type costs.

The prosthesis can be bought independently in a specialized store or ordered via the Internet. The service is possible provided that you have agreed in advance all the nuances, found out the required type of prosthesis.

In the cities of Russia there are companies - official distributors of foreign manufacturers of orthopedic implants. More often you can hear about "Legacy MED" (works with the world famous American company "Johnson & Johnson"). Here you can buy titanium and ceramic endoprosthesis. The consultant will tell you the exact price.

Dislocation of the hip prosthesis

The development of such a pathology as hip dislocation after replacement is a rare case; it is diagnosed no more than 2-4 times per 100 operated patients. Symptoms are indistinguishable from dislocation to replacement. The clinical picture is as follows:

• the development of a pain syndrome that is not amenable to relief with painkillers;
• change in the length of the lower limb, its shortening;
• violation of the amplitude of movement, stiffness, a sharp decrease in physical activity.

To clarify the stability of the design, the patient is introduced into a state of anesthesia, where the doctor deliberately subluxes the prosthesis, then sets it back to its original position. This procedure allows us to assume the causes that provoked the complication, and in the future to reduce the risk of re-dislocation.

The treatment consists in the reduction of the dislocation and the subsequent wearing of a special prosthesis, a course of physiotherapy exercises, physiotherapy, and massage.

Zimmer: hip prostheses

A well-known manufacturer of orthopedic equipment, a company founded in the USA over a hundred years ago - Zimmer (Zimmer). Throughout the entire period of its existence, the company has been constantly developing, introducing the latest technologies, creating new designs, prostheses. Its products are transported to different countries of the world, used in medical centers in Israel, Germany, Russia, and the Czech Republic.

Such popularity is associated with the quality of products: it is distinguished by durability and high adaptive capabilities.

The range of the company is wide, it is possible to choose a prosthesis in the price-quality ratio. Even inexpensive implants allow you to completely imitate the native joint and have good wear resistance.

What prosthesis can be purchased, how long does it last? Zimmer manufactures the following implant structures:

• knee replacement prosthesis. The undisputed leader: almost half of the operations are performed with the use of prostheses from this company. Service life - 15 and more years;
• endoprostheses for replacement of the shoulder joint. Unique innovative development - a joint with a maximum level of implantability, restoring hand functions by 95%;
• implants for hip replacement. Large selection of species, there is the possibility of individual selection, including the price.

The main difference between Zimmer products is the high adaptation of the prosthesis, which shortens the rehabilitation period.

According to statistics, the artificial joints of this manufacturer in 99% of cases remain stable for 10-12 years after installation. In almost 85%, the Zimmer's lifespan is approaching 15-18 years. Therefore, such popularity of the company is quite justified.

Patients often ask the following question: is it possible to put our prostheses, how many years will they last? The quality of domestic manufacturers is not much worse, there are many worthy orthopedic companies. When answering another question, there are many factors to consider. Here everything depends no longer on the price of the implant, but on the chosen design - a friction pair, the skillful hands of a doctor and a rehabilitologist.

cost of the hip joint

Rarely, complications develop after joint replacement surgery; in 10% they are associated with an incorrectly selected implant. Patients are diagnosed with a fracture of the neck, the development of an infectious process, edema, hematoma.

Fact: there is no specific prosthesis - a universal model that could fit everyone and not provoke side effects.

The main mistake of many patients is to make a choice of an endoprosthesis design based on reviews from the Internet and on price. A person chooses the most expensive foreign-made prosthesis and performs the operation with a surgeon with little experience. As a result, adaptation is poor, recovery is long, and there are many complications.

If you decide on arthroplasty, pay attention - the price of an implant, Zimmer or ceramic, has nothing to do with the success of the treatment. It makes sense to opt for an inexpensive but suitable orthopedic item for you.

An experienced surgeon has his own preferences in models and brands, so a preliminary consultation and selection is essential. Experts, both private institutions and public medical centers, are more likely to advise choosing Zimmer and DePuy. Although the prostheses of these manufacturers do not have a fundamental difference, they are completely similar in appearance, these are high-quality products with the ability to choose a design taking into account financial capabilities.

Joint treatment More >>

How much does treatment with such endoprostheses cost? The average price in Moscow is 200,000 rubles, taking into account a stay in a private clinic, laboratory tests, a hospital and subsequent rehabilitation under the supervision of a specialized doctor.

There is an important point in orthopedic surgery: the basis of a successful recovery is recovery. Not one, even the most expensive, prosthesis guarantees the success of the operation without following the rules of rehabilitation.

In practice, there are enough examples when patients, acquiring the most innovative and expensive implant, completely ignored the restoration, believing that it was not needed due to the high price. The result - patients returned after a few years to the doctor with complaints of pain, swelling, development of lameness. In this case, there can be no conservative treatment - a revision surgery is prescribed, followed by additional costs and long-term rehabilitation.

Very often, replacing a native joint with an artificial one is the only way to restore the normal functioning of the musculoskeletal system. Approach responsibly to the choice of prosthesis, diagnosis, clinic, doctor and further recovery.

Hip arthroplasty is often the only possible way to return to full activity and avoid disability in patients who have suffered a fracture of the femoral neck. Replacement of the femoral head, acetabulum and the hip joint itself with a prosthesis made of chemically and biologically inert materials can significantly reduce pain, restore full joint mobility and preserve limb functions.

What is an endoprosthesis

The endoprosthesis of the hip joint is its artificial imitation and consists of the following parts:

• cups - an artificial acetabulum with a polyethylene liner;
• the head of the prosthesis, which is a hinge, usually spherical;
• stem implanted to the medullary canal of the femur, round or square in cross section.

Endoprostheses are designed in such a way that they can fully preserve all the functional features of the hip joint. Prostheses can differ in the method of attachment, as well as in the materials of manufacture - both are taken into account individually, since the selection of the prosthesis is carried out taking into account the age, weight, expected physical activity of the patient and many other factors.

In what cases is the replacement of the joint with an endoprosthesis indicated?

Indications for an artificial hip replacement surgery are:

Classification of implants

Depending on the design of the endoprosthesis, the method of their attachment to the femur, and the materials of the rotational cup-head pair, several types of implants are distinguished.

Types of implants by their design

Depending on whether an acetabular prosthesis is intended or a natural recess will be used to accommodate the head of the prosthesis, two types are distinguished:

• unipolar - without prosthetics of the acetabulum;
• bipolar - with a cup imitating the acetabulum.

The most technically advanced and durable are bipolar prostheses, as they allow reducing the abrasion of cartilage tissue by the head of the prosthesis.

Types of implants according to the method of their attachment

Depending on the method of fixing the implant in the medullary canal and pelvic bone, there are:

• Endoprostheses with cementless fastening. Such constructions are inserted into the bone tissue without any fixing compositions, in the expectation that over time there will be an “ingrowth”, consolidation of the implant with the bone tissue. Implants of this type have a special porous shell into which bone tissue grows over time. This method is most often used in operations in young patients, since in them the processes of regeneration and tissue repair occur most quickly and actively, allowing you to fix prostheses without clamps.
• Endoprostheses with cement fastening. In elderly patients, as well as in patients with autoimmune, endocrine, genetic diseases that reduce the density and strength of bone tissue, the prosthesis is most often attached using special cement.
• Endoprostheses with a mixed method of attachment. Implants of this type combine two methods of attachment at once: a cup imitating the acetabulum is attached to the pelvic bone in a cementless way, and the prosthesis leg is fixed in the medullary canal with cement.

Types of implants according to the materials of manufacture

Depending on the materials from which the friction pair is made - the bowl and the head of the prosthesis - it is customary to distinguish the following types:

• Metal - polymer. The stem and head of the prosthesis are made of a biologically and chemically inert metal, most often titanium, and the acetabular cup is made of a special polymer. The soft polymer material of the bowl can significantly reduce friction. This type of implant is one of the most affordable. The friction products of the polymer do not enter the bloodstream and can only cause local reactions in the form of tissue edema, as well as increase the risk of loosening of the parts of the prosthesis in the bone tissue. Many manufacturers create products with a polymer cup impregnated with vitamin E to reduce the destructive effect of friction products on the bone membranes.
• Metal is metal. All parts of the prosthesis are made of metal. Implants of this type are used less and less, as the products of friction of metal parts against each other often cause complications, including metallosis. The smallest chips formed by rubbing the head against the bowl enter the bloodstream, causing local and systemic reactions of the body. Metal-to-metal rotating prostheses often cause swelling in the area of ​​the operation, which limits the patient's mobility.
• Ceramics - ceramics. All parts of the prosthesis are made of heavy-duty ceramics. Such implants are considered among the best, as they create minimal friction and rarely cause postoperative complications. Due to the complexity of execution, the price of a ceramic hip joint is relatively high. The disadvantages of this type of implants include the characteristic crunch emitted by its parts during rotation, which often becomes a cause for concern for patients.
• Ceramics - polymer. In prostheses of this type, the stem and head are made of heavy-duty ceramics, and the bowl is made of polymeric materials. Due to the low degree of thorns and high wear resistance, this type of prosthesis can be attributed to the most commonly used. The disadvantage of this type of prosthesis can be considered their fragility: excessive loads can cause the destruction of the implant.

Manufacturers of hip endoprostheses

Among the most widely represented materials for endoprosthetics on the market, the following companies can be distinguished:

• Zimmer (Zimmer) is an international corporation based in the USA and has more than a century of history. The company supplies its products to medical centers in the USA, Germany, the Czech Republic, Russia, and Israel. The assortment includes a wide range of products from simple metal-polymer to high-tech ceramic prostheses. In the recent past, the company merged with another major manufacturer of implants, Biomet.
• Johnson&Johnson is a world-famous corporation based in the USA, the manufacturer of the Pinnacle line of prostheses, which are widely used worldwide for hip replacements.
• Stryker is a company founded by physician G. Stryker in the 1940s in the USA. The company's products are well established in the market due to their high quality, but the cost of the company's products is relatively high.
• Smith&Nephew is a UK-based company that offers wear-resistant and durable products over a century ago. It is one of the largest suppliers of medical equipment worldwide.

In the world market, an increasing share is being taken by the products of companies from China and Taiwan, offering products at a lower cost. However, there is no exact data on the quality of products from Asian manufacturers, since in our country the percentage of their installation remains very low.

Average cost of hip arthroplasty

The price of hip endoprostheses varies depending on the materials used in its manufacture and the manufacturer.

• A classic bipolar prosthesis with a metal-polymer friction pair, when properly used, can have a long service life up to life. The cost of such a product varies in the range from 90 to 150 thousand rubles. Analogues at a lower cost can be found in Asian manufacturers of medical equipment.
• A metal unipolar prosthesis made of titanium can cost from 75 thousand rubles and more. Bipolar - from 100 and above, respectively.
• Ceramic prostheses with the lowest coefficient of friction and wear are among the most expensive: the price for products of this type starts from two hundred thousand rubles.

How to choose an implant

The choice of an endoprosthesis is a very individual process, there is no material, shape, method of attachment that is ideal for all patients at once. The choice of the type of endoprosthesis is the task of the surgeon who will perform the operation to install it. Weight, age, bone density, general health, lifestyle - all of these factors will be taken into account when choosing prosthetics.



When choosing an endoprosthesis, it is necessary to take into account the age, weight and activity of the patient.

Prostheses with a metal-polymer rotation pair are most suitable for people over 60 years old, but they can also be used in younger people, provided that they do not play sports and other types of physical activity that involve increased stress on the articular joints. Friction products of a high-molecular polymer do not penetrate into the bloodstream and cannot cause systemic reactions, however, they increase the risk of loosening of the cup in the acetabulum or the leg of the prosthesis in the bone canal. When using this type of product, an annual radiographic examination is recommended to assess the condition of the polymer bowl.

Prostheses with a metal-to-metal friction pair are most often used by people who lead an active lifestyle, including professional athletes, who need a wide range of motion and high wear resistance of the product. These types of artificial joints are suitable for patients with large body weight due to the high load on the musculoskeletal system. There is evidence that prostheses with this friction pair cause more complications in female patients than in men, but the reasons for this dependence have not yet been found. The use of endoprostheses of this type is not recommended in women planning future pregnancy.

Ceramic prostheses are suitable for all age groups, however, due to their high cost, the use of this type of product is not always advisable. The disadvantages of ceramic joints include their relative fragility: a strong impact, for example, when falling, can cause their destruction.

The high cost and quality of the prosthesis do not guarantee the success of the operation; the experience and professionalism of the surgeon are much more important.

Rehabilitation plays one of the most important roles in the success of treatment. In medical practice, there are many cases when patients, despite all the prescriptions of doctors, refused to perform rehabilitation measures, citing the fact that the high cost of the prosthesis should minimize the risks of complications, and eventually, after a few years, they were again forced to seek medical help. due to pain in the area of ​​the replaced joint. Unfortunately, conservative treatment in this case is impossible, the only way out is a repeated revision intervention followed by a long rehabilitation period.

Endoprosthesis installation technique



When choosing a technique for installing an endoprosthesis, several factors are taken into account at once:

• the age of the patient and his state of health;
• condition and density of bone tissue;
• the scale and nature of pathological changes;
• personal experience of the surgeon.

Access to the area of ​​operation can be carried out posteriorly, anteriorly, anterior-laterally or in a combined way. In most cases, it is the posterior approach to the area of ​​prosthetics that is used as the least traumatic.

After the incision is made, the surgeon exposes the joint capsule, shifting the fascia and muscles, and resects the damaged areas. The head of the femur is removed, the acetabulum is scraped or also completely removed. The medullary canal is cleaned, and the leg of the prosthesis is fixed into it with the help of cement or metal rods. The bowl is fixed in place of the acetabulum. Next, the distal region of the prosthesis is checked, if no deviations are found, its head is fixed in the bowl, and then the tissue layers are sutured in layers.

Replacement of the hip joint with an artificial one is a complicated but often necessary operation. In most cases, only prosthetics allow the patient to avoid prolonged immobilization, which is associated with the risks of developing complications in the cardiovascular and respiratory systems, which often cause death in elderly patients, or deep disability.

Compliance with the doctor's instructions and the implementation of the prescribed rehabilitation measures allows you to return to a full-fledged active life in a short time, and with proper use, replacement of the prosthesis may never be necessary during your life.

For patients with stage 3 coxarthrosis, doctors recommend arthroplasty, an operation during which an artificial hip joint is implanted. If the endoprosthesis was correctly selected, the operation was performed by an experienced specialist, the patient underwent a course of postoperative rehabilitation, and the leg functions are restored. For elderly people, the endoprosthesis can serve for life, young people usually need a second operation (revision). But even a single operation is not affordable for many. The cost of arthroplasty depends not only on the skill level of the surgeon, but also on the cost of the endoprosthesis. Does a high-quality prosthesis have to be expensive?

Manufacturers of endoprostheses

1. Zimmer provides an 8-year warranty on products, in practice, hip prostheses of this brand last 15 years or more. At the same time, they are more affordable than the products of other international companies. So, the estimated cost of a unipolar prosthesis is 75 thousand rubles.
2. Biomet, DePuy from the Johnson & Johnson concern, Smith & Nephew are brands popular on the international market, but less in demand in Russia, their products are about twice as expensive as similar Zimmer models.
3. Stryker is a more expensive brand than Zimmer, these endoprostheses are marginally, on average, 10% cheaper than the products of the companies listed in point 2.
4. Copies of promoted American and European brands of Taiwanese, Chinese production. The cost of the prosthesis is about 1.5–2 times lower than the original.

Is it worth saving by purchasing clones of famous brands? It is quite possible that prostheses produced in Asian countries are not inferior in quality to European or American originals. But these products appeared on the market relatively recently, and so far there is no information regarding their actual service life.

Every well-known international company has its own chips. For example, DePuy covers the legs of cementless dentures with hydroxyapatite, and Zimmer equips some models with ribs for more secure fixation. Biomet is known for making cups (acetabular substitute) without liners, although this technology is now being adopted by other manufacturers. Zimmer's cementless Trilogy cups have smaller holes than DePuy's Pinnacle cups. On the one hand, this increases the contact area of ​​the prosthesis with the bone, on the other hand, it complicates the control of the installation of the endoprosthesis in place.

Each company produces dozens of varieties of prostheses, which is better, it is impossible to say for sure. Much depends on the individual preferences of surgeons: it is more convenient for someone to work with one model, for someone else. The femoral stem and cup must be configured on an individual basis. So, it cannot be said that a straight leg is better than a curved one and vice versa, it all depends on the anatomical features of the canal in the femur. In the same way, the statement that a cheaper cement prosthesis is worse than an expensive cementless prosthesis will be incorrect. It is necessary to take into account the condition of the bone tissue, which depends on the age and sex of the patient. Different materials for the manufacture of prostheses also have their pros and cons.

Partial and total dentures

In the formation of the hip joint, 2 bones take part - the femur and the pelvic. The head of the femur enters the acetabulum of the pelvis. Depending on the indications for arthroplasty, the degree of destruction and deformity of the joint, it is possible to restrict the replacement of the femoral component (unipolar, partial arthroplasty) or change both components, femoral and acetabular. A total hip arthroplasty, consisting of 2 components, is about 1.5 times more expensive than a unipolar one.

The following factors also affect the cost of the prosthesis:

• a method for fixing the stem of the femoral component in the medullary canal and the cup in the reamed acetabulum;
• the materials from which the friction pair is made (the head of the femoral component and the liner in the cup);
• design complexity – an anatomical curved stem is more expensive than a universal straight stem, since production costs are higher. Modular legs and multi-piece cups are more expensive than monolithic ones.

An artificial joint with a modular stem is used if a significant part of the femur is affected. The need to use a modular cup arises in the presence of defects in the acetabulum. The shape of a standard cup is corrected with the help of side overlays (augments), which often have to be made according to an individual project.



Cemented and uncemented fixation

Cement-retained prostheses are installed using the tight fit method, driven into a previously prepared seat. They have a rough surface, the bone tissue grows into these roughnesses over time, and the prosthesis with the bone forms a single whole. Cement prostheses have a smooth surface and are fixed with bone cement - polymethyl methacrylate. Immediately before the operation, the powder is mixed with the liquid, the liquid solution polymerizes and hardens 5–8 minutes after preparation. Polymethyl methacrylate in the hardened state combines mechanical strength with high elasticity, able to absorb loads.

Cement-retained dentures are cheaper than cement-retained ones. Within both categories there is also a variation in prices, in particular, the method of making the surface rough or smooth matters. The surface of the legs of tight-fitting prostheses can be processed in the following ways:

• baking compressed balls or wire fibers;
• sandblasting;
• plasma spraying of metal;
• non-metallic coating (hydroxyapatite, calcium phosphate).

The same methods, with the exception of sandblasting, are used for cementless cups. The surface of the legs of cemented prostheses can be polished or satin. Polishing is more expensive, but in practice it has not been proven that a polished surface provides a more secure hold than a satin finish.

What fixing method is best?

There is an opinion that the cementless prosthetic technique is more progressive, of high quality, and provides the most reliable fixation. In fact, everything is not so simple, for one patient an artificial hip joint with cementless fixation is better, for another - with cement. Cement prosthetics are preferred:

• if the patient suffers from osteoporosis (bone density decreases with age, especially in women after menopause);
• if the bone canal is wide and the walls of the femur are thin;
• after fractures of the femoral neck, especially ununited;
• with osteomyelitis and a high risk of infectious complications (an antibiotic can be added to the cement).

The ingrowth of bone tissue into the prosthesis theoretically provides a more reliable fixation than cementing. In addition, this method of fixation simplifies revision surgery. Therefore, young people who actively load the artificial joint and who eventually need to replace it, it is better to perform a tight fit.

But there is a risk of damaging the bone by driving a prosthesis into it, so you need to take into account not only age, but also individual structural features and bone density. Bone cement polymerizes in minutes, but it takes months for bone to grow into a prosthesis. Therefore, the load on the joint after cementless prosthetics should be gentle, after cement fixation, full rehabilitation is faster.

There are also hybrid prostheses: the leg of the femoral component can be driven into the canal, and the cup can be cemented, and vice versa (reverse hybrid). Sometimes, with severe sclerosis of the acetabulum, they resort to additional fixation of cementless cups with screws through the holes.

Denture materials

The components of cemented and cementless prostheses are made from different materials. In the manufacture of endoprostheses, metal alloys are used: titanium, cobalt, iron, zirconium, high molecular weight polyethylene and ceramics. Ceramics is the most expensive material, metal and polyethylene are cheaper. Each component has its own set of materials.

The legs of the femoral component are exclusively metal, the composition of the alloy depends on the method of attachment:

• for cement fixation - based on cobalt with chromium, the composition of the alloy may also include molybdenum;
• for cementless - from a titanium-aluminum alloy with the addition of vanadium or niobium.



Similar titanium-based alloys are also used for cementless cups (acetabular components). Cement is made from high molecular weight cross-linked polyethylene, they are used without liners. The cup liner (or the inner surface of the cup itself) forms a friction pair with the head of the femoral component. Heads are metal and ceramic, liners in cementless cups are made of metal alloys, ceramics and polyethylene. Both components of the friction pair can be made of the same material (metal-metal, ceramic-ceramic) or different (metal-polyethylene, ceramic-polyethylene).

For metal heads, alloys based on iron, titanium and cobalt are used. Each has its own strengths and weaknesses. Titanium heads pair well with titanium stems, but they cause active abrasion of the liners. Contact of a cobalt alloy head with a titanium stem can be accompanied by corrosion. At present, titanium heads are practically not produced, the improved cobalt-chromium alloy and the PROTASUL alloy, which is sometimes called stainless steel, are more popular. In fact, it vastly outperforms conventional stainless steel in strength and durability. Recently, heads made of zirconium alloys have begun to appear, resistant to wear, corrosion, and low toxicity.

Pros and cons of different friction pairs

Metal is a relatively affordable, durable and at the same time elastic, shock-resistant material. The main disadvantage of metal friction pairs is abrasion and penetration of the smallest metal dust into fabrics. In particular, in order to avoid toxic effects on the fetus, endoprostheses with a metal-to-metal friction pair are not installed in pregnant women. A pair of ceramics-ceramics is characterized by high wear resistance, no toxicity. Ceramic is a hard but more brittle material than metal, theoretically ceramic heads and inserts can break. Although the latest generation of ceramic elements combine wear resistance with impact resistance.

Another drawback of endoprostheses with a ceramic friction pair is a pronounced creak during movements, although many prostheses function silently. And their main disadvantage is the high cost, at a price they are 1.5–2 times higher than metal ones. The combination of a metal head with a polyethylene liner is the most budget option. But such friction pairs are short-lived, wear out quickly. Therefore, such prostheses are mainly installed in the elderly. Upon contact with the ceramic head, the polyethylene liner does not wear out as actively as in the previous version, but such a friction pair is also short-lived and belongs to the budget ones.

An expensive endoprosthesis is not always better than a budget one. When choosing these products, the priority is not financial considerations, but how a particular model suits a particular patient. Not all endoprostheses are interchangeable. If the operation is performed on a quota, the patient can be implanted with a cheap cemented prosthesis, although he would be better off with a cementless prosthesis. But it is impossible to use a unipolar prosthesis if there are indications for total prosthetics. Among the products of well-known manufacturers, the products of the Zimmer brand are distinguished by the optimal price-quality ratio.

There is a problem of choosing an implant. The attending physician will offer options, but it is better for the patient to understand the diversity of endoprostheses. What is the best artificial joint and how much does it cost?

For cementless fixation

Types of hip implants

The manufactured hip replacements are of high quality. This applies to all manufacturers operating in Europe or the USA. Therefore, it is incorrect to talk about which of the prostheses is better or worse.

The main essence of the difference between endoprostheses is a friction pair formed due to the materials from which the head and the artificial acetabulum (or insert) are made.






How are dentures fixed?

The difference in design depends not only on the friction pair. In some patients, the acetabulum, to which the femoral head is attached, is also affected. In this case, the doctor will have to replace both parts of the damaged joint. This operation is called total arthroplasty.

Types of implant fixation in the bone:

• Cementless prosthesis. Both unipolar and bipolar artificial structures can be inserted into the patient's own femur without the addition of luting cement. It is used in young patients in order to increase the durability of the product.
• Cement. Necessary in elderly patients and those with autoimmune diseases. Due to the fragility of one's own femur, the pin of the metal structure is additionally strengthened with cement. It has little effect on rehabilitation, since it is possible to install any pair of friction.



Location scheme.

Any artificial structure will last for many years with proper operation. The main disadvantage of ceramic prostheses is fragility and a characteristic crunch. If the first problem makes itself felt in 0.5% of all patients, then judging by the reviews, the crunch in the operated joint, which is well audible to other people, excites many.



This is what a cracked ceramic head looks like.

For a metal-metal friction pair, a problem of a completely different kind is typical. In the process of wear, tiny chips are formed, which are absorbed into the bloodstream and cause a local reaction. There are local swelling of the tissues, and much less often - a systemic reaction to the metal. Edema significantly limits the mobility of patients, but can be treated conservatively. However, long courses of therapy do not contribute to the joy of people who have an expensive artificial joint installed.



Metal oxides under the metal head.

Metal-polyethylene and ceramic-polyethylene friction pairs have less irritating effect. But they are also characterized by local edema, but with a much milder course. However, high physical loads are completely unacceptable, as they dramatically increase the wear of the structure.



How ceramics can destroy surrounding materials. Total wear.

Hip joint: prosthesis price

The pharmacy does not sell artificial implants for endoprosthetics. They are operated by several firms in large cities. The price will depend on several factors:

• dealer margin;
• brand;
• design features;
• purchase directly from the official representative or through an intermediary in the hospital;
• workmanship and specific model of the prosthesis.

Endoprostheses of almost all firms are presented in Moscow. The cheapest implants are offered by the Taiwanese "UOC", however, doctors' reviews of this manufacturer are quite wary. The essence of the low price is obvious - Chinese and Taiwanese companies are simply cloning models of European firms.

A titanium prosthesis from a well-known manufacturer in Moscow costs 99-120 thousand rubles. Asian designs are about 2 times cheaper. If the friction pair is ceramic-ceramic, then the price fluctuates within 200 thousand rubles. The average check of the classic metal-polyethylene design does not exceed half of the ceramic product. When buying in a hospital, an additional markup is possible, masked by additional medical services.

Buy a hip prosthesis in Moscow

Before you independently purchase an artificial implant, you need to discuss its design with a specialist. It is important to consider what lifestyle the patient leads. With active sports at a young age, you will have to choose durable special designs. Prices in Moscow:

• Zimmer. This international corporation, successfully operating for many years, offers value for money. A single-pole titanium prosthesis will cost from 75 thousand rubles. Bipolar for total arthroplasty is about 1.5 times more expensive. Ceramics costs 200,000 rubles.
  
  
• Johnson Johnson. Despite the popularity of the brand, the share of its products on the Moscow market is low. The firm offers prosthetics under the DePuy brand. The average check of simple products exceeds 150 thousand rubles.
  
• Biomet. Despite the high quality of endoprostheses, they are rarely bought. Implants are more expensive than Zimmer, buying a bipolar implant will cost 140-150 thousand rubles, ceramics - about 2 times more expensive.
  
  
• Stryker. Well-established international corporation. It has a wide range of products. High prices are comparable to those of Johnson-Johnson. Stryker products are only 8-12% cheaper.
  
  
• Smith&Nephew. A rare guest on the Russian market. However, dentures are durable and wear-resistant. The price is comparable to Biomet.
  
  
• Chinese companies and manufacturers from Taiwan. They produce clones of all famous American and European brands. The price is usually 1.5-2 times cheaper. But due to the small percentage of installations in Moscow, it is difficult to assess their quality.

How much a hip joint implant costs in the capital of the Russian Federation depends on many reasons, especially on the manufacturer. However, a ceramic endoprosthesis is always 50-70% more expensive.

Zimmer - hip prostheses

Is it possible to put these prostheses? The answer is positive, since the products undergo multi-level control at the production site, and then they are installed in patients. Those patients who have had a hip replacement note the highest quality of life after several months of rehabilitation. Reviews indicate that the service life of Zimmer prostheses exceeds 15 years. It is not possible to interview many patients, because due to their advanced age they die due to natural causes. Pathological anatomical autopsies show low wear of structures even after many years of operation.

The main advantages of Zimmer endoprostheses can be summarized as follows:

• price;
• huge model range;
• ease of installation;
• design reliability;
• long service life;
• low complication rate;
• wide distribution network.

How long does a prosthesis last for patients? With proper use, the patient will be able to fully move all his life. More than 75% of people end up with a primary implant.

For zimmer designs, the service life is prescribed in the instructions for use of the product. How many years does the manufacturer guarantee? At least 8 years of full movement. The prosthesis does not add body weight to the patient, since how much the product weighs is strictly specified in the contract with the buyer. Weight, depending on the design, does not exceed 500 grams. Patients are always interested in the question, is it possible to run or play active sports? But in this case, the answer depends on the brand of the installed design. With ceramic prostheses, active sports are allowed, including running.

The cost of a hip prosthesis

Zimmer prostheses are the most popular, and the range has all the necessary types of orthopedic implants. What are the best implants from the company? It depends on how the patient will use it. For normal everyday life with a low pace, all design options are suitable. Price in Moscow.

• Classic bipolar implant. Equipped with a metal-polyethylene friction pair. Durability - up to life with moderate use. The amount that the manufacturer asks for the product usually does not exceed 120 thousand rubles.
• Unipolar titanium prosthesis. The cheapest option. Only the head of the femur is prosthetized, and the acetabulum remains its own. It is impossible to select a friction pair, it always contains metal components. Start price tag - from 75 thousand rubles.
• Ceramic. The most expensive type of construction. It has a minimal gradient of friction and wear. The price starts from 200 thousand rubles.



Black ceramic, which is more expensive and more durable than regular pink or yellow.

To summarize, the question of how much a design from Zimmer costs depends directly on the model. The price in Moscow starts from 75 thousand rubles.

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