{"id":1793,"date":"2019-05-03T10:36:32","date_gmt":"2019-05-03T08:36:32","guid":{"rendered":"https:\/\/www.cematec.org\/traumatologia\/protesis\/protesis-de-maluc\/"},"modified":"2022-06-16T21:58:46","modified_gmt":"2022-06-16T19:58:46","slug":"protesis-de-maluc","status":"publish","type":"page","link":"https:\/\/www.cematec.org\/ca\/traumatologia\/protesis\/protesis-de-maluc\/","title":{"rendered":"Pr\u00f2tesis de maluc"},"content":{"rendered":"

Es ent\u00e9n<\/span> per<\/span> pr\u00f2tesis<\/span> de maluc<\/span> o artropl\u00e0stia<\/span> total de maluc<\/span><\/strong> la restauraci\u00f3<\/span> o substituci\u00f3<\/span> de una<\/span> articulaci\u00f3<\/span> deteriorada<\/span> i dolorosa<\/span> per<\/span> uns<\/span> components<\/span> met\u00e0l\u00b7lics<\/span> (crom<\/span> , cobalt<\/span> , molibd\u00e8<\/span> , titani<\/span> , oxinium<\/span> ), cer\u00e0miques<\/span> i polietilens<\/span> .<\/p>\n

Tots<\/span> aquests<\/span> components<\/span> es solen<\/span> combinar<\/span> de diferents<\/span> formes<\/span> per<\/span> allargar<\/span> la vida<\/span> de la pr\u00f2tesi<\/span> a base de disminuir<\/span> la fricci\u00f3<\/span> entre<\/span> les<\/span> diferents<\/span> peces<\/span> .<\/p>\n

D’<\/span> altra<\/span> banda<\/span> , es fan<\/span> esfor\u00e7os<\/span> molt<\/span> importants<\/span> perqu\u00e8<\/span> aquests<\/span> components<\/span> es<\/span> uneixin<\/span> al os<\/span> de una<\/span> forma estable<\/span> i harm\u00f2nica<\/span> , ja<\/span> que<\/span> es tracta<\/span> de ajuntar<\/span> uns<\/span> metalls<\/span> que<\/span> s\u00f3n inerts<\/span> amb un os<\/span> viu i canviant<\/span> que<\/span> respondran<\/span> a les<\/span> diferents<\/span> necessitats<\/span> de \u00fas<\/span> .<\/p>\n

\"\"<\/p>\n

A quant<\/span> al desgast<\/span> de les<\/span> pr\u00f2tesis<\/span> , es han<\/span> aconseguit<\/span> uns<\/span> metalls<\/span> ho prou<\/span> durs<\/span> , units<\/span> a polietilens<\/span> de alta<\/span> densitat<\/span> o b\u00e9<\/span> la combinaci\u00f3<\/span> de cer\u00e0miques<\/span> , metalls<\/span> endurits<\/span> perqu\u00e8<\/span> la<\/span> durada<\/span> de les<\/span> mateixes<\/span> puguin<\/span> sobrepassar<\/span> els 20 anys<\/span> .<\/p>\n

\"\"<\/p>\n

Les pr\u00f2tesis<\/span> s’uneixen<\/span> a l’ os<\/span> b\u00e9<\/span> sigui per<\/span> cargols<\/span> , roscades<\/span> , o cimentades<\/span> , depenent<\/span> de l’ edat<\/span> i la qualitat<\/span> \u00f2ssia<\/span> de la persona.<\/p>\n

QU\u00c8<\/span> PUC<\/span> FER<\/span> DESPR\u00c9S<\/span> D’ OPERAR<\/span> ? <\/strong><\/p>\n

Durant<\/span> les<\/span> primeres<\/span> 24-48 hores<\/span> haur\u00e0 de<\/span> romandre<\/span> a llit<\/span> i portar<\/span> uns<\/span> drenatges<\/span> perqu\u00e8<\/span> no<\/span> apareguin<\/span> hematomes<\/span> dins<\/span> de la articulaci\u00f3<\/span> . Tampoc<\/span> hauria de<\/span> fer<\/span> rotacions<\/span> o flexions<\/span> importants<\/span> per<\/span> evitar<\/span> una<\/span> luxaci\u00f3<\/span> de la maluc<\/span> ja<\/span> que<\/span> la mobilitat<\/span> entre<\/span> els components<\/span> \u00e9s<\/span> congruent<\/span> , per\u00f2<\/span> entre<\/span> ells<\/span> nom\u00e9s<\/span> se mantenen<\/span> pel<\/span> to<\/span> muscular.<\/p>\n

Entre<\/span> el 3r i 6\u00e8 dies<\/span> es podr\u00e0<\/span> seure<\/span> en un butaca<\/span> alta, amb les<\/span> cames<\/span> separades<\/span> i iniciar<\/span> la marxa<\/span> sempre<\/span> amb la ajuda<\/span> de dos bastons<\/span> , ja<\/span> que<\/span> no es posseeix<\/span> la for\u00e7a<\/span> ni<\/span> seguretat<\/span> suficients<\/span> .<\/p>\n

Depenent<\/span> de la qualitat<\/span> \u00f2ssia<\/span> i si<\/span> la pr\u00f2tesi<\/span> est\u00e0<\/span> cimentada<\/span> , es podr\u00e0<\/span> recolzar<\/span> el pes del cos<\/span> al caminar<\/span> per\u00f2<\/span> s’haur\u00e0 de<\/span> posposar<\/span> i ser<\/span> progressiu<\/span> si<\/span> la pr\u00f2tesi<\/span> \u00e9s<\/span> sense cimentar<\/span> . Tot<\/span> aix\u00f2<\/span> \u00e9s<\/span> perqu\u00e8<\/span> es<\/span> una<\/span> i remodeleu<\/span> el os<\/span> amb el metall de la pr\u00f2tesi<\/span> i es evitin<\/span> dolors<\/span> innecessaris<\/span> als mesos<\/span> seg\u00fcents<\/span> .<\/p>\n

Podreu<\/span> caminar<\/span> i pujar<\/span> escales<\/span> a partir<\/span> del 6\u00e8 al 8\u00e8 dia<\/span> de postoperatori<\/span> . Passejar<\/span> , a setmanes<\/span> successives<\/span> , sempre<\/span> amb la ajuda<\/span> de bastons<\/span> i amb el suport<\/span> de la extremitat<\/span> que<\/span> el seu<\/span> cirurgi\u00e0<\/span> li indiqueu<\/span> .<\/p>\n

HE<\/span> EFECTUAR<\/span> REHABILITACI\u00d3<\/span> A LES SETMANES<\/span> SEG\u00dcENTS<\/span> ?<\/strong><\/div>\n

Es poden<\/span> i han d’<\/span> efectuar<\/span> exercicis<\/span> isom\u00e8trics<\/span> fins i tot<\/span> llit<\/span> per<\/span> evitar<\/span> la atr\u00f2fia<\/span> muscular, per\u00f2<\/span> no necessitar\u00e0<\/span> de una<\/span> fisioter\u00e0pia<\/span> activa<\/span> i especialitzada<\/span> , ja<\/span> que<\/span> la deambulaci\u00f3<\/span> preco\u00e7<\/span> i el m\u00ednim<\/span> dolor que<\/span> pugui<\/span> tenir<\/span> no li crearan<\/span> contractures<\/span> ni<\/span> rigideses<\/span> que<\/span> no es puguin<\/span> v\u00e8ncer<\/span> caminant<\/span> . Haur\u00e0 de<\/span> practicar<\/span> una<\/span> higiene<\/span> postural asseient<\/span> -se amb les<\/span> cames<\/span> obertes<\/span> , a cadira<\/span> alta<\/span> i col\u00b7locar<\/span> un suplement<\/span> al WC per<\/span> estar<\/span> assegut<\/span> m\u00e9s<\/span> alt del que \u00e9s habitual.<\/p>\n

El dolor sol<\/span> desapar\u00e8ixer<\/span> just<\/span> despr\u00e9s<\/span> d’ operar<\/span> i necessita<\/span> poca<\/span> analg\u00e8sia.<\/p>\n

Si no existeix<\/span> una<\/span> contraindicaci\u00f3<\/span> per<\/span> part<\/span> del cirurgi\u00e0<\/span> , entre<\/span> les<\/span> 6-8 setmanes<\/span> podr\u00e0<\/span> nedar<\/span> , conduir<\/span> i valdre’s<\/span> per<\/span> si<\/span> mateix<\/span> a les<\/span> tasques<\/span> habituals<\/span> , per\u00f2<\/span> no hauria d’<\/span> iniciar<\/span> cap<\/span> feina<\/span> que<\/span> necessiti esfor\u00e7os<\/span> .<\/p>\n

\"\"<\/p>\n

A les<\/span> pr\u00f2tesis<\/span> sense cimentar<\/span> no s’hauria d’<\/span> abusar<\/span> de la carrega<\/span> perqu\u00e8<\/span> la<\/span> pr\u00f2tesi<\/span> es estabilitzi<\/span> i es remodeleu<\/span> el os<\/span> . Aix\u00f2<\/span> \u00e9s<\/span> particularment<\/span> desitjable<\/span> al pacient<\/span> jove<\/span> perqu\u00e8<\/span> la<\/span> pr\u00f2tesi<\/span> sigui duradora<\/span> i no es afluixeu<\/span> per<\/span> un exc\u00e9s<\/span> de sobrec\u00e0rrega.<\/span><\/p>\n

EXISTEIX<\/span> REBUIG<\/span> O AFLOXAMENT<\/span> DE LA PR\u00d2TESIS<\/span> DE MALUC<\/span> ?<\/strong><\/p>\n

\n

Amb els materials<\/span> actuals<\/span> i excepte a casos<\/span> molt<\/span> excepcionals<\/span> per<\/span> al\u00b7l\u00e8rgia<\/span> als metalls<\/span> , sobrec\u00e0rregues<\/span> excessives<\/span> no es afluixen<\/span> les<\/span> pr\u00f2tesis<\/span> de maluc<\/span> , per\u00f2<\/span> pot<\/span> passar<\/span> que<\/span> torni<\/span> el dolor o coixesa<\/span> de forma progressiva<\/span> al cap<\/span> dels anys<\/span> necessitant<\/span> un recanvi<\/span> de la pr\u00f2tesis<\/span> .<\/p>\n

El per<\/span> qu\u00e8<\/span> es afluixa<\/span> una<\/span> pr\u00f2tesi<\/span> encara<\/span> segueix<\/span> discutint-se<\/span> , per\u00f2<\/span> s\u00ed<\/span> relacionat<\/span> amb la col\u00b7locaci\u00f3<\/span> poc<\/span> depurada<\/span> , exc\u00e9s<\/span> de pes, exc\u00e9s<\/span> de sol\u00b7licitaci\u00f3<\/span> al treball<\/span> o esport<\/span> a pacients<\/span> joves<\/span> o pels<\/span> residus<\/span> del desgast<\/span> de materials<\/span> .<\/p>\n

Un<\/span> cop<\/span> es inicia<\/span> el proc\u00e9s<\/span> de afluixament<\/span> , el dolor i la coixesa<\/span> solen<\/span> ser<\/span> habituals<\/span> i no es hauria d’<\/span> esperar<\/span> molt<\/span> per<\/span> efectuar<\/span> el recanvi<\/span> de la pr\u00f2tesi<\/span> ja<\/span> que<\/span> complica<\/span> enormement<\/span> el seu<\/span> rescat<\/span> , necessiten<\/span> pr\u00f2tesis<\/span> especials<\/span> i les<\/span> intervencions<\/span> s\u00f3n complexes<\/span> .<\/p>\n

Sempre<\/span> es investiguen<\/span> noves<\/span> pr\u00f2tesis<\/span> de maluc<\/span><\/strong> , per<\/span> preservar<\/span> el m\u00e9s gran l’estoc ossi<\/span> i augmentar<\/span> la mobilitat<\/span> a gent<\/span> jove<\/span> , ja<\/span> sigui per<\/span> una<\/span> necrosi avascular o seq\u00fcela<\/span> d’un accident<\/span> , per\u00f2<\/span> els resultats<\/span> a molt<\/span> a llarg termini<\/span> encara<\/span> no es coneixen<\/span> .<\/p>\n

\"\"<\/p>\n<\/div>\n<\/div>

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