Dr Orlin Filipov, MD, PhD, chief doctor of Vitosha Hospital, has years of experience in orthopedics and traumatology. He has specialised in arthroplasty, and has trained in reconstructive surgery at Israel. His researches have been published in renowned European specialised magazines.
Are fractures in elderly patients untreatable? How do you help such patients?
Fractures of elderly patients are treatable and when surgery is done well, they recover without follow-up problems. In some cases, like all fractures of the large bones of the lower limb, treatment is only surgical. In others, like the upper part of the shoulder bone or above the wrist, non-surgical treatment is also possible. Rehabilitation is always an important part of the treatment. Fractures of hip bone are a special injury associated with increased risks for the patient, posing a huge social burden for the ageing society globally.
These fractures are treated only surgically. We operate such patients as soon as possible, after consultations with a cardiologist, anaesthesiologist, and other specialists. If the patient's general condition doesn't allow an operation in the first few hours after admission, an immediate treatment of the accompanying diseases begins, aiming at improvement of the general condition within maximum 24 hours, followed by the surgery.
You have specialised in Israel, and in Vitosha hospital you apply special operative methods developed in this country for faster movement recovery. Tell us more about it?
There are two main types of surgical procedures we apply: osteosynthesis and endoprosthetics. All kinds of fractures are an object of osteosynthesis (internal fixation) with metal implants. However, in fractures of the femoral neck at patients over the age of 65-70 years, the total hip replacement with an endoprosthesis is usually applied as a standard procedure.
In total hip joint replacement procedures, we use a method that provides excellent stability in the zone of the endoprosthesis. This guarantees lack of mechanic complications and allows the patients to regain their movement and independence much faster. This method also has less blood loss than conventional surgery, and as a result we often don't need to do a blood transfusion, with all the risks of it.
Another type of operations, where we apply 'tricks' improving the surgical technique, are those for hip bone fractures. In spite of osteoporosis, we achieve excellent strength of the fracture fixation, which allows the patient to step with his full weight on the operated leg immediately, on the first day after the surgery.
This, sadly, is hardly achievable with conventional surgical methods, where the fixation strength is usually weaker and therefore patients are not allowed to step with full weight bearing during the first 2 or 3 months after the surgery.
What should the patient know before he undergoes total hip or knee replacement surgery?
There are few things, and here are some of them. Endoprosthetics is the ideal solution for patients with osteoarthritis – gonarthrosis or coxarthrosis. The optimal recovery period for a physically and mentally healthy person is about 2 months, but in some old and polymorbid patients it can be significantly longer. Patients with an endoprosthesis should take care of the lowered immunity associated with some conditions, like during a heavy fly, and the following risks of infections. In such cases, antibiotic prophylaxis is recommended. As for endoprosthesis durability, the endoprosthesis usually should be replaced with a new one each 11-14 years.
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