[Comprehensive rehabilitation of patients with osteoporosis after hip arthroplasty]

Most people who have undergone hip arthroplasty belong to the older age groups, so they often have signs of osteoporosis. A decrease in bone mineral density in combination with a decrease in local blood circulation caused by additional trauma to bone structures and surrounding soft tissues during surgery contributes to osteolysis, early instability of the endoprosthesis and increases the risk of periprosthetic fractures.

To study the effectiveness of the developed rehabilitation complex, including the combined effect of a physiotherapeutic factor (increased gravity) and antiresorptive therapy, in patients with osteoporosis who underwent hip arthroplasty.

The study included 40 patients aged 60-75 years with signs of osteoporosis, who underwent total hip arthroplasty, no more than 3 weeks ago. The patients were randomized into two groups: the main group - 16 (40%) people, comparisons - 24 (60%) people. To assess the effectiveness of rehabilitation complexes, orthopedic examination, functional diagnostics of motor pathology of the lower extremities on an automatic hardware-software complex, X-ray densitometry, and indicators of the visual analogue pain scale and Harris scale were evaluated. Patients of both groups were prescribed a rehabilitation complex, including therapeutic exercises, mechanotherapy for training the thigh muscles and electrical stimulation of the thigh muscles, a course of 10 procedures. Patients of the main group were additionally prescribed a course of gravitational and antiresorptive therapy according to our methodology.

The intensity of pain before treatment in patients of both groups corresponded to moderate pain syndrome. After 3 months after the course of rehabilitation, the pain intensity in the patients of the main group decreased statistically significantly by 3.1 times, in the patients of the comparison group - by 2.6 times. When assessing the biomechanical data of walking at the beginning of the rehabilitation course, the asymmetry of pressure indices was revealed in patients of both groups, corresponding to the average degree of lameness. After 3 months, the asymmetry coefficient in the patients of the comparison group reached a mild degree, while in the patients of the main group it approached the norm. According to X-ray densitometry, after 12 months, the bone mineral density index only in patients of the main group increased to the level of osteopenia. The indicator of the combined assessments of the Harris scale was statistically significantly different between the groups at 3 and 6 months after the course of rehabilitation.

The combined use of gravitational therapy and antiresorptive drugs in the treatment and rehabilitation complex in patients with osteoporosis who have undergone total hip arthroplasty helps to reduce pain, reduce signs of osteoporosis, improve the functional parameters of patients' activity, and increase household and social adaptation.