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Deforming osteoarthritis (DOA), which develops on the basis of trauma, congenital dysplastic or inflammatory disease, can lead to a serious deterioration in all life activities. This manifests itself in constant, oppressive pain, the inability to move normally and do the same work. It often leads to disability. One of the methods of treatment of DOA is arthroplasty. Many believe that after a knee or hip replacement, they automatically give disability.. Is it so?

Disability in DOA and after arthroplasty

There are a lot of indignant letters on the Internet on medical forums, something like this:

My mother, a nurse at City Hospital No. 2, underwent surgery a year ago. Since then, she has been in constant pain, especially her leg aches before a change in the weather. She can't bend her knee like she used to, she can't run. They submitted documents to the ITU, but after the operation they didn’t give her any group ... Why? ..

To understand this, let's consider the principle by which they generally give disability in diseases of the musculoskeletal system.

The basis for assigning a disability group may be:

• Deforming arthrosis of both hip or knee joints not lower than the second stage of arthrosis and a moderate degree of joint dysfunction
• DOA of one or more joints (hip, knee, ankle, shoulder, elbow, wrist) in stage III, with ankylosis or limb shortening
• Bilateral arthroplasty leading to severe disorders

Thus, in itself - is not yet a basis for disability. On the contrary, surgery can be recommended in the late stage of DOA as a method of treating arthrosis and the possibility of removing a number of life restrictions (LIA)

A person agrees to an operation, not wanting to become disabled, but on the contrary, wanting to avoid disability.

Another thing is when the joint replacement was unsuccessful for some reason:

• The quality of the prosthesis is low
• The surgeon did not conduct computer navigation and unsuccessfully selected the geometric dimensions of the prosthesis
• After the operation, the patient did not undergo rehabilitation or did not go through it as it should

A referral to the MSE after arthroplasty is given in the event of moderate and severe musculoskeletal disorders that led to the limitation of the patient's life activity (OIA)

Let's consider how the degree of musculoskeletal functions is determined and by what criteria the OZh is evaluated at the ITU.

Medical and social expertise in deforming arthrosis

Post-traumatic arthrosis is considered the most unfavorable in its course, since it differs:

• The most pronounced dysfunctions (contractures, restriction of movements, shortening of the leg, muscle atrophy)
• Increased frequency of exacerbations
• The rate of disease progression

For MSE, the following criteria for assessing the patient's condition are required:

1. X-ray diagnostics according to Kosinskaya
2. Functional diagnostics
3. Determination of the degree of statodynamic function (SDF)
4. Determination of the degree of moderation in the development of DOA:
   • How quickly the disease progresses
   • How often do exacerbations occur?
   • What are the complications of the disease

X-ray diagnostics at ITU

Diagnostics in medical and social expertise differs from the usual diagnostics that is used in modern medical practice:

• So, the degrees of arthrosis in medical orthopedics on the basis of x-rays are today determined according to the Leuquesne classification - it distinguishes four degrees of arthrosis
• At ITU, the degrees of arthrosis are determined only according to the classification of Kosinskaya (three degrees)

The third degree according to Leuquesne may correspond to the second according to Kosinskaya, which may cause disputes.

Degrees of DOA according to Kosinskaya

First degree DOA:

• Slight restriction of movement
• Mild and uneven narrowing of the interarticular gap
• Initial osteophytes

Second degree DOA

• Restriction of joint movement in certain directions
• The appearance of a rough crunch when moving
• The narrowing of the gap by two to three times, in comparison with the norm
• Moderate muscular atrophy
• The appearance of large osteophytes
• Signs of osteosclerosis and cystic cavities in the epiphysis of the subchondral bone

Third degree DOA

• Large joint deformities and compaction of bone surfaces
• A sharp limitation of mobility with the preservation of rocking movements in the range from 5 to 7 ˚
• Large osteophytes over the entire surface of the joint
• Joint gap closure
• Fragments of cartilage in the synovial cavity of the joint (articular mice)
• Subchondral brushes

With complete fusion, not DOA is diagnosed, but ankylosis, which is informally considered the fourth stage of arthrosis

Functional diagnostics in arthrosis

There are four degrees of limitation of joint movements:

First degree:

• Limitation of movements of the shoulder, hip joint - no more than 20 - 30 ˚
• The amplitude of the knee, ankle, elbow, wrist joints is not less than 50 ˚ from a functionally advantageous position
• Brush amplitude - from 110 to 170 ˚

Second degree:

• Restrictions of hip movements and - no more than 50 ˚
• Knee, elbow, wrist - decrease in amplitude to 20-45 ˚

Third degree:

• Preservation of the amplitude within 15 ˚, or ankylosis and immobility in a functionally uncomfortable position

Fourth degree:

• Fixation of the joints in a tightened functionally uncomfortable position

Degrees of statodynamic function (SDF)

In many respects, the maintenance of these functions, thanks to which we continue to maintain support and move even in the later stages of osteoarthritis, occurs with the help of compensatory processes, the purpose of which is:

• Eliminate the difference in the lengths of the limbs due to the distortion and inclination of the pelvis
• Alleviate contracture leading to limb shortening by increasing mobility of adjacent and contralateral (opposite) joints
• Improve the support of the diseased limb by transferring the load to the healthy leg, etc.

In addition to clinical signs (shortened limb, pelvic tilt and muscle atrophy of the diseased limb), compensation is confirmed by X-ray:

• Bone sclerosis is observed in the most loaded area of ​​the joint
• The support area of ​​the joint increases
• In the diseased joint, signs of osteoporosis and cystic degeneration are observed.
• In adjacent joints, the opposite joint of a healthy limb and the lumbar region, DDD begins

There are four degrees of SDF:

Minor violation of SDF

• Amplitude reduction no more than 10 ˚
• The appearance of aching pain after a deadlift or walking three to five km at a pace of 90 steps per minute
• Pain goes away after rest
• The first stage is determined by x-ray
• Compensation indicators are normal

Moderate SDF violations

Moderate violations (initial stage)

• Pain and lameness when walking 2 km, disappearing after rest
• Stride pace - 70 to 90 steps per minute
• The average number of steps at a distance of 100 m is 150
• moderate contracture
• Support shortening - no more than 4 cm
• The circumference of the affected thigh is reduced by two centimeters
• Muscle strength is reduced by 40%
• X-ray determines the first-second stage of DOA
• Musculoskeletal functions and compensatory mechanism correspond to the degree of relative compensation

Moderate violations (late stage)

• The patient complains of constant pain in the joint, lameness, pain when starting to move.
• He is able to walk no more than one kilometer, and then with the help of a cane
• Walking pace from 45 to 55 steps per minute with the number of up to 180 per 100 m
• Arthrogenic contracture is expressed
• Shortening of the limb - from 4 to 6 cm
• Hypotrophy progresses:
  • The difference in the girth of a healthy and diseased hip reaches from 3 to 5 cm
  • Healthy and diseased lower leg - one - two cm
• Decreased muscle strength - 40 - 70%
• X-ray determined the second - third stage of DOA
• Changes begin in the joints of the lumbar and lower extremities without neurological symptoms
• The mechanism of compensation corresponds to the degree of subcompensation (compensation is insufficient, its tasks are difficult to accomplish)

Severe violations

• Intense pain in the diseased joint, in the lumbar and contralateral joint
• Pronounced lameness, inability to walk more than 0.5 km without rest (using a cane, one or two crutches)
• Walking pace from 25 to 35 steps per minute, with at least 200 steps per 100 meters
• Severe arthrogenic contracture
• Shortening of the limb - more than 7 cm
• Hypotrophy of the thigh in the difference in the lengths of the circumferences of the patient and healthy thigh - more than 6 cm, hypotrophy of the lower leg - more than 3 cm
• Reduced muscle strength - more than 70%
• According to X-ray - the second - third stage
• Degenerative-dystrophic changes in the joints of the limbs and lumbar with neuroradicular syndrome
• This stage corresponds to the musculoskeletal functions of decompensation (complete impossibility of compensation)

Significantly pronounced changes in SDF

• This is actually the inability to move independently.
• The patient mostly lies and moves with great difficulty only within the apartment, with outside help or with the help of crutches (walkers)

Types of the course of the disease

Slowly progressive:

• It takes at least 9 years from the onset of the pathology to the appearance of pronounced changes.
• By type of compensation - compensated arthrosis
• Synovitis exacerbations are rare (once every one to two years)
• No reactive synovitis

Progressive:

• Process development time: 3 – 8 years
• Subcompensated type of arthrosis
• Secondary reactive synovitis with exacerbations twice a year
• There are signs of cardiovascular disorders: hypertension, atherosclerosis

Rapidly progressing:

• Arthrosis develops within no more than three years
• Decompensated type
• Reactive synovitis with exacerbations at least three times a year
• Associated pathologies

Basis for assigning a disability group

Minor persistent violations of the SDF in the first and second stages of arthrosis of one joint are not the basis for assigning a disability group

• The basis for the establishment of the 3rd group may be persistent moderate dysfunctions of the SDF:
  • The third stage of DOA of the hip joint or bilateral (gonarthrosis) of the second stage with the first degree of limitation of the range of motion of the joints
• Reasons for the second group of disability - persistent pronounced violations of the SDF, leading to the second degree of mobility restriction
  • Bilateral coxarthrosis with severe contractures 2-3 stages
  • Ankylosis of the knee, ankle and hip joints
  • coxarthosis and

That's behind the operation to replace the hip joint, rehabilitation has come to replace. The most important thing now for the patient is to be extremely attentive to their feelings and successfully go through all the stages without allowing complications. There is no need to be afraid, they occur infrequently and, as a rule, if a special regimen is not observed, which is prescribed from the first day after surgery. The duration of rehabilitation treatment is approximately 3 months, of which the patient spends 2-3 weeks in the clinic, and the rest of the time he will either continue classes and undergo procedures at a good specialized medical center, or will work at home strictly according to the instructions issued.

Where is it better to undergo recovery - at home or in the clinic?

After hip replacement surgery, rehabilitation not only at an early stage, but also at a later stage is also better to be carried out under the supervision of an orthopedist and a professional exercise therapy instructor. Why is it so important? In the later stages, you can overestimate your capabilities by starting to put more stress on the operated joint than it is ready to accept at the moment, which is fraught with dislocation of the endoprosthesis, loosening and other troubles. Usually this happens precisely in the remote period, being at home, when, against the background of a significant improvement in the condition, a person decides that he can already go beyond the limits. In fact, the final strong bonding of the prosthesis to the bone and muscle structures has not yet taken place, and it occurs no earlier than in 3-4 months, here is the result.

Why is specialist supervision needed? Because only he is able to convey to the patient the essence of the recovery process. Without extraneous instructions, even the most disciplined and informed patient is unable to provide rehabilitation.

It is advisable to stay as long as possible under the supervision of specialists who, taking into account the dynamics of recovery and the individual characteristics of the patient, will select the optimally acceptable level of physical activity, make adjustments as necessary in the direction of increasing or reducing them, and monitor the correct performance of each exercise. The rehabilitation instructor and the attending physician will make sure that rehabilitation after hip replacement goes without complications, providing the full range of mandatory preventive measures in time.

During the exercises, something will certainly pull, whine, hurt, but only a physiotherapist who has had many such patients will be able to sensibly explain the reasons and inspire confidence.

Wherever the patient goes through the postoperative plan of mandatory measures, he must strictly adhere to an individual rehabilitation program after hip replacement. It is compiled exclusively by a highly qualified specialist, according to established standards for endoprosthetics, for a specific medical case.

Sequence, timing and main features of the stages

Orthopedic surgeons strongly advise 3 weeks after the operation to undergo a treatment and recovery stage in the orthopedic department of a surgical hospital, then about the same in a specialized rehabilitation center. After that, to consolidate the results obtained, undergo a course of rehabilitation in an institution of a resort and sanatorium type, specializing in the profile of therapeutic and prophylactic treatment of the musculoskeletal system.

Early physical rehabilitation

From the information provided in the table, you can see that recovery after surgery is not a matter of one week, but an average of 3-4 months. Complicated patients can recover from six months to a year. So, let's consider what the initial rehabilitation phase is.

Goals and objectives

The principles of recovery after surgery on the hip joints in the initial period are mainly based on the use of balanced kinesitherapy, gentle static exercises, myostimulating physiotherapy procedures. In addition, the patient receives competent medical care, including antibiotic therapy, the introduction of vascular preparations, and antiseptic treatment of the wound. Thanks to proportionate and targeted exercise therapy, adequate treatment with medications, the following is achieved:

• stimulation of blood circulation in the lower extremities;
• elimination of inflammation, edema, painful syndrome;
• increase in muscle strength and range of motion in the problem area;
• correction of the statics of the vertebral sections;
• prevention of postoperative negative reactions (thrombosis, infections, etc.) and the development of strong immunity against all possible consequences.

Compression cuffs are a mandatory measure for the prevention of thrombosis in the first days after surgery.

Also, from the first day, such a device for passive extension of the joint has been used. Used for both knee and thigh.

This period ensures the implementation of one of the main goals - the early activation of the operated patient. A rehabilitation doctor, an instructor-methodologist in exercise therapy must teach a person all the norms of physical behavior, confident use of aids for movement; help develop the correct stereotype of walking and adopting a “sitting” position, climbing and descending stairs. Also, their duties include warning the patient about all types of physical activity that are strictly contraindicated in this period of time.

Physical Mode

• respiratory diaphragmatic gymnastics;
• training a healthy limb through active exercises, as well as flexion/extension of the ankle of the endoprosthetic leg until a feeling of slight fatigue in the muscles of the leg;
• strengthening the gluteal, femoral and calf muscles with the help of isometric tensions of the corresponding zones;
• raising the pelvic region, leaning on the elbows and foot of a healthy lower limb, in order to prevent bleeding and necrosis of the skin due to their compression due to a long stay in bed;
• from 2-3 days include up to 6 times a day for 15 minutes individualized passive-active training on the leg with a replaced joint (raising a straight limb, sliding the feet on the bed with pulling the legs towards you, bending the knee joint area by less than 90 degrees;
• special strengthening exercises for the adductor and abductor muscles, as well as the hip extensor muscles (“Hula-hula”, Thomas test, etc.).

After approximately 2 days, the patient is allowed to sit down (sit for no more than 15-20 minutes), while the doctor will prescribe more exercises performed in the “sitting” position, for example, unbend the leg at the knee joint, holding it in the extension position for 5 seconds (10 sets each). 5-6 times / day). Also, from the third day, the patient begins to get up, stand and walk a little on crutches, not yet transferring body weight to the problem side. The duration of walking is at first equal to 5 minutes, but the time is slowly added, and by the end of this period you need to walk three times a day for about 30 minutes.

A separate area of ​​rehabilitation is occupational therapy, when the patient is taught to take care of himself safely: get up and lie down on the bed, put on socks and shoes, other clothes, pick up things from the floor, use crutches, etc.

The support on the leg is added very carefully, starting from a slight touch of the foot with the floor surface, gradually increasing the percentage of the support load. Having mastered the “standing” position well, the patient, under the guidance of a methodologist, will learn to carry out:

• abduction in the lateral and posterior direction of the straightened leg, holding on to the back of the bed, chair or walker, avoiding pain;
• bending the knee with pulling the heel to the buttocks, straining the gluteal part;
• controlled transfer of weight from one leg to another, from side to side, etc.

Precautionary measures

You already know how long the rehabilitation after the replacement of the hip joint of the musculoskeletal system takes, and that in the early stages the supporting-power frame of the body is too weak. Therefore, in order to avoid displacement of the functional components of the endoprosthesis (dislocation) or instability at the points of attachment of the artificial hip joint, strictly follow the instructions below.

1. Do not exceed 90 degrees of hip flexion, especially with internal rotation and adduction.
2. It is impossible to give a full axial load to the prosthetic segment. This is dangerous by loosening the implant.
3. Do not sit on chairs, sofas, beds with low surfaces. Appropriate furniture should be high enough.
4. Avoid vigorous and forced movements in the joint, both at the time of self-service and during restorative exercise therapy. Forget about the “leg over leg” position, this position is strictly forbidden for at least 4 months!
5. In classes aimed at restoring the hip joint after total hip replacement surgery, be careful that the legs do not approach each other and do not intersect.
6. Do not take any medications that have an analgesic effect immediately before exercise or during exercise. They powerfully suppress pain sensitivity, due to which control over one's own sensations is lost during physical exertion, which can greatly harm the operated leg.
7. Do not lie on the problem side either during sleep or during normal rest. Rest on your healthy side using a roller or small pillow between your two limbs. They will protect against sudden unsuccessful movement, which can disrupt the congruence of the articular elements of the endoprosthesis. It is preferable to sleep on your back at first, while also do not forget to put a delimiter pillow between your legs.

The roller between the legs is a mandatory requirement for a month after the operation. Crossing the legs increases the risk of dislocation of the implant.

How long the rehabilitation of the early cycle will last after the replacement of the hip joint is decided only by the doctor on an individual basis. If all goals and objectives are achieved in full, the state of health satisfies the deadlines, recovery is progressing according to plan, then the patient is transferred to the next stage - the longest and no less responsible.

At an angle of less than 90 degrees in the hip joint, this risk is also high.

Late stage recovery system

About 3 weeks have passed since the day the hip replacement was performed, rehabilitation becomes more varied, longer in time and intensity. The specialist adds to the established physiotherapy treatment, namely electromyostimulation and ultrasound, more procedures for musculoskeletal microcirculation and optimization of osteoreparation processes:

• medicinal electrophoresis of calcium, possibly bischofite;
• infrared laser therapy;
• balneological treatment;
• acupuncture;
• paraffin therapy and ozocerite applications;
• massage of the lumbosacral zone of the spine and a healthy leg.

There is nothing better than a pool for recovery, but do not forget that before this the seam must heal!

Therapeutic exercise already consists to a greater extent of dynamic exercises, resistance training and weight training. The patient, under the supervision of a methodologist, performs a diverse complex of exercise therapy on special simulators, as well as using sports equipment, such as rubber bands, light weights, step platforms, and block shells.

Suspension work is a great way to engage your deepest muscles.

The main goals of the late period

The fundamental goals at this stage are the physical development of the lower limb until full functionality is reproduced in it, work on gait and posture, and improvement of the ligamentous-muscular center. The base of measures for the implementation of the tasks set is again kinesitherapy. Physiotherapy is not canceled, after the replacement of the hip joints in rehabilitation it is given an equally significant place. So, now all treatment and recovery measures are aimed at:

• the maximum possible expansion of the motor-supporting functions of the limb, the achievement of absolute stability of the hip joint and a full range of motion;
• regulation of muscle tone to normal, increased muscle endurance;
• development of symmetrical support-kinematic work of both legs;
• correction of adaptive habits during movement, which the patient had to follow before and after surgery due to motor failure and fear of pain.

As before, the rehabilitation instructor works with the ward on his adaptation to a new lifestyle, on the development of stable movement patterns that he will use in self-care, while doing homework, and also outside the home.

Nordic walking is good for its safety.

It is important to understand that immediately and by itself after a complex operation on the musculoskeletal system, the effect will not occur. The way the rehabilitation will proceed and how long after the replacement of the hip joint will be significantly affected, first of all, by the adequacy of the type, frequency, intensity and duration of daily physical activity given to the joint. The effectiveness and approach of the recovery time is influenced by the patient's diligence in relation to medical instructions, overcoming one's own laziness, weakness and fear.

Attention! It is important to understand that the TBS has been replaced with an artificial organ. Yes, this is an analogue organ that coincides with the configuration and functional parameters of the anatomical and physiological unit, but in any case it is not a biologically native element. In order for the “new” part of the musculoskeletal system to become an inseparable link in a single locomotor chain, harmoniously coordinated with all anatomical structures, which is a rather complicated process, it takes time and a therapeutically competent, purposeful effect on the prosthetic leg.

Later period balance exercises are suitable for those who want to get the most out of their treatment.

Hiking now increases in duration to 60 minutes, in frequency - up to 4 times a day. After 1.5-2 months, perhaps a little earlier or later, the supervising doctor will cancel the use of crutches, allowing the use of a cane when moving. The cane is used until the complete recovery of the operated department is confirmed. Usually it is canceled and allowed to do without support at all between the 13th and 17th week.

Basic complex of late exercise therapy

The number of repetitions of one type of exercise is 6-10 times, the cycle of the complex is 2-3 times a day.

Before using a gymnastics technique, consult a doctor to make sure that none of the exercises has contraindications for your medical problem.

Rehabilitation after a total joint replacement with an endoprosthesis at these times also includes cycling and aqua gymnastics. In addition, it will be very useful for the patient to swim in the pool with the front crawl style. But do not forget about the gradual transition to new types of physical education methods and a reasonable increase in the pace, strength and time of recovery sessions. At periods such as 3, 6 and 12 months, it is necessary to undergo a mandatory control and diagnostic examination in the clinic.

Advice! If you are far away from going to the pool, it’s winter outside and you don’t really take a walk, the exercise bike takes up a lot of space, then buy a step machine. This is an incredibly effective projectile for training the lower extremities.

And the last point that interests many people who have undergone hip arthroplasty, but what are they embarrassed to ask a specialist about: when is intimate life allowed? You can’t have sex until the unnatural joint is securely fixed in the bone structures and firmly attached to the muscles and ligaments - the main “levers” that bring the prosthesis into a functional state. And this is possible, as we have repeatedly noted, after 90-120 days after prosthetics with a successful recovery.

Based on the foregoing, we denote that a certain percentage of patients do not fit into the generally established standards of rehabilitation. At the end of 90-120 days after arthroplasty with an unsatisfactory clinical picture, the ITU expert commission will deal with the issues of granting the status of VUT to the patient.

To do this, the medical institution (HCI), where the patient was treated and examined during the entire rehabilitation period, sends a package of documents to the local bureau. The parcel package necessarily includes all extracts and conclusions on the main diagnosis, on diagnostic and therapeutic measures carried out in outpatient and inpatient conditions. That is, the health care facility, according to the collected documentation, officially confirms the fact that the patient has depression of functions of one nature or another and the need to undergo specific medical rehabilitation.

Experts of the medical and social commission carefully study the information about the patient received from the health facility and pass a verdict on the degree of limitation of his performance. The ITU, as one of the most common options, can agree that the polyclinic opens a new one from the date of closing the sick leave until the patient's quality of life is restored to the fullest extent possible. The terms of the BL are also set for the health facilities by the ITU, however, as well as the admissibility of its extension without their participation, the cyclicity of the update. Another option, less likely, is that the expert commission assigns a disability group (usually 3 gr.) to the patient with its further re-examination at the time indicated by the MS-instance.

We emphasize that MSEC reserves the right to refuse both the extension of the BC and the assignment of the group if the pathological deviations are confirmed as minor.

Hip replacement surgery is one of the most difficult, after which a long recovery is required. If a person works, and most often it happens, you have to worry not only about your health. Sick leave required at work. The problem is that immediately after the operation it is impossible to say exactly how long the rehabilitation will last and how the artificial prosthesis will behave: will a person be able to lead a full-fledged lifestyle or will he have to apply for disability and leave work.

Recovery period after endoprosthetics

According to the law, after such an operation, rehabilitation lasts 3 months: 2 weeks a person is in the hospital under the supervision of doctors and then continues to be treated at home. Immediately after discharge, an open sick leave is issued for a period of 3 months.

Why it happens:

• a person must adhere to an individual schedule of classes under the supervision of exercise therapy specialists, therefore, be at home;
• at first, heavy loads should not be given, because the prosthesis has not yet taken root in the body and there is a danger of dislocation, a person should always be able to lie down and rest - this is impossible at work;
• 90% of people after endoprosthetics experience severe pain in a sitting position, therefore, frequent changes in position and the use of painkillers are required - if the work is sedentary, a person needs to go through the recovery stage in a calm environment;
• if you do not adhere to the regimen within a year after the operation, complications are possible in the form of dislocation, fractures. The risk increases in elderly people with concomitant diseases or endocrine disorders; working pensioners after arthroplasty should be more attentive to their health after surgery.

Even a year after hip replacement, up to 22% of patients complain of pain. These are official statistics, so you need to be prepared to extend the sick leave in case of continuous pain that will prevent you from working normally.

The primary development of the joint should take place under the strict supervision of the medical staff

Discharge from the hospital after hip surgery occurs after 3 weeks. Must pass:

• acute stage and end the inflammatory reaction;
• wound healing, which is controlled by doctors;
• recovery initial period, also controlled by the clinic staff.

At home, a late recovery period lasts, in which bone tissue is renewed and the body adapts to the prosthesis.

3-4 months is the minimum period that is given to a patient who is in good health. It is difficult to imagine that when bone tissue is destroyed, the body works like a clock. In most cases, returning to work after a hip replacement is delayed.

How to extend sick leave after arthroplasty

If, after 3 months, a person is unable to go to work for health reasons, the issuance of sick leave is transferred to the attending physician. He can issue sick leave for up to 15 days, based on the patient's well-being. That is, a person must come to the hospital 2 times a month or more often - as the doctor says.

After 4 months from the date of the onset of temporary disability, sick leave is closed. Further, the following is possible:

1. The man goes to work.
2. The doctor applies for recognition of the patient as disabled. A medical and social examination is appointed and the person is recognized as disabled. The group is determined by the members of the commission on the basis of the available documents on the state of health.

If health does not improve or a person wants to spend more time at home and devote it to recovery, a temporary disability option is possible. Immediately after the joint replacement surgery, disability documents are submitted, the amount of payments is determined, and the patient sits at home. A year later, the documents are submitted again, after which the disability can be removed and the person starts working. In case of health problems, the disability is extended and he further receives disability benefits.

The sheet of temporary disability with a slow recovery and adaptation, but with positive dynamics, can be extended up to 7-8 months.

Difficult situations with disability recognition

If conservative treatment does not help a person, one has to resort to surgical intervention. But it often happens that after the operation a person is not able to fulfill his labor obligations. How does the medical and social examination proceed in this case:

1. Logically, an operation is done to a person in order to improve his well-being. After the operation, the patient should feel better, but he applies to the authorized bodies to recognize him as disabled.
2. Disability may not be assigned and the patient is at a loss - how to continue to live.

The way out is as follows: to sue a medical organization, justifying this by the fact that before the operation the person did not have a disability, but after the surgery he needed it, because the condition worsened. Thus, it is possible to challenge the decision of the ITU.

Controversial situations with sick leave, temporary disability and disability arise when a person undergoes surgery on both hip joints at the same time. The period of sick leave after hip arthroplasty on both sides depends on the patient's condition, the dynamics of the recovery process, but does not exceed 2-3 months. Further, it is possible to extend the sick leave or temporarily issue a disability. Much depends on the position that a person occupies: if it is an office sedentary job, then he is theoretically able to perform it. If it is severe physical, associated with lifting weights or constantly being on your feet, then it is better to immediately apply for disability and adapt to prostheses. A year later, the group may not continue.

A controversial situation in which you need the help of a lawyer and the advice of a doctor is associated with the alternate replacement of TBS. If the duration of sick leave after hip arthroplasty on one side is 3-4 months, and the next operation is scheduled in 5-6 months, is it worth going to work or spending time at home taking care of your own health. Practicing lawyers who specialize in social issues are advised to apply for disability after the first operation, calmly wait for the next one and recover after two surgical interventions.

There are cases when the decision of the ITU allows a person to be sent for retraining if the previous place of work is not available for health reasons, and temporarily receive disability benefits. In any case, the terms for extending the sick leave are within the competence of the attending physician, who also sends the person to the commission and writes his opinion on the condition of the operated joints. Therefore, it is necessary to seek help from him.

To apply for the ITU, documents are collected - x-rays, the duration of the sick leave after hip replacement surgery or both, a copy of a diploma, a work book. Of great importance is the presence of concomitant diseases and the length of stay in hospital.