Lula: understand the risks of the president’s surgery – 09/29/2023 – Equilíbrio

Total arthroplasty surgery, popularly called hip prosthesis, is indicated when there is a fracture in the femur or bone degeneration in the region, as in the case of President Luiz Inácio Lula da Silva (PT). Associated risks include those inherent to surgical treatments, such as reaction to anesthesia or infection, and others linked to the postoperative period, such as dislocation of the prosthesis, chronic pain and difference in leg size.

According to doctors interviewed by Sheet, the patient also needs to “behave”, and correctly rest and rehabilitate after the intervention, which can be time-consuming. In the case of the president, who fulfills commitments linked to his position on a daily basis, recovery may be compromised if post-operative guidelines are not respected.

Post-surgical indications include walking with support, such as a walker, being careful with leg flexion and avoiding overload.

Leandro Calil De Lazari, member of the International Society of Hip-Preservative Surgery and head of the Medical Residency Service at Hospital São Lucas, says that the literature points to a good recovery rate.

“Around 98% experience satisfactory results after surgery. The main risks affect approximately 2% of cases. Some patients may experience chronic pain after surgery, although this is less common,” he says.

With a PhD in Orthopedics and Traumatology from USP (University of São Paulo) and the Università Cattolica di Roma, Lazari draws attention to the possibility of infection at the site during the procedure, a complication that requires immediate treatment.

In rare cases, dislocation may occur, when the prosthesis comes out of place and requires additional intervention, and a change in the length of the lower limbs, which causes a difference in size between the legs.

“Hip prosthesis surgery is widely recommended in cases of hip osteoarthritis, femoral head necrosis, dysplasia and other conditions that cause pain and limited movement. However, it is important that it is carried out in highly complex hospitals, with ICU support. [Unidade de Terapia Intensiva] and a complete medical team coordinated by a specialized orthopedist”, he reinforces.

Preoperatively, the patient must undergo a series of clinical examinations, in addition to cardiological and anesthetic evaluation. “If any health problem is identified, it must be treated before surgery, which is only contraindicated in cases of serious illnesses with high surgical risk,” she says.

According to Henrique Melo de Campos Gurgel, orthopedist at VITA at Grupo Fleury, this type of procedure can also cause nerve damage and a new fracture, which can happen intraoperatively. “To avoid [os riscos], the surgery must be performed by a specialist. And the patient must behave well post-operatively, that is, be careful with hip movements”, he ponders.

The operated party needs to maintain leg flexion at a maximum of 90º. “Thus, depending on the patient’s height, it is necessary for them to use a toilet seat lift or a toilet chair to avoid too much movement of their prosthesis”, says Gurgel.

Another point of attention after the procedure concerns overload. “Initially, the patient must walk with some support, such as a walker, and then migrate to a crutch or cane until six to eight weeks after surgery. By taking appropriate care with the weight-bearing of the operated leg, the patient ensures good integration from the prosthesis to the body and good healing of the muscles”, says Gurgel.

Orthopedist and traumatologist Tania Szejnfeld Mann, head of the Foot and Ankle Medicine and Surgery Group at Unifesp (Federal University of São Paulo) and member of Hospital Israelita Albert Einstein, remembers that it is a complex procedure.

“It’s a major surgery, which needs a lot of care from the point of view of preparing the team, room, material.”, says Mann.

The professional says that the technique would be used more if it weren’t for the high cost, especially because of the implants, although it is the main surgery for those with advanced hip osteoarthritis. “There is a rapid and significant improvement in quality of life after they undergo this type of procedure,” she says.

Geriatrician Natan Chehter, member of the SBGG (Brazilian Society of Geriatrics and Gerontology) and the Mário Covas State Hospital, says that this surgery is generally performed on those who have had joint problems that can no longer be treated in any other way. “It’s usually a resource that we use after the patient has already undergone other treatments, precisely because it requires hospitalization and recovery,” he says.

The complication of this treatment, for the geriatrician, arises from the need for gradual mobilization of the patient. “You need days of rest, without putting your foot on the ground. Afterwards, partial weight-bearing has to be applied. The patient has to use crutches, a walker, a cane, to distribute this weight.” Then comes rehabilitation, with muscle strengthening and regaining balance, and only then returning to the ground.

Adapting to the prosthesis, in turn, can generate discomfort, squeaking and pain. “Any surgery on the elderly is usually more risky, because they have fewer functional reserves. When they are hospitalized, they lose a lot of muscle mass, they have a greater risk of thrombosis and bleeding. They are not prohibited from surgery, on the contrary, when properly indicated, there is to do, but it increases rehabilitation time and, often, the need for pain medication, which can have side effects”, points out the geriatrician.