The artificial hip joint

The hip joint is a ball joint. The joint partners are the thigh bone and the pelvis.
patient information

How does our hip work?

 

The hip joint is a ball and socket joint and the second largest joint in the human body. The femur and pelvis are the joint partners. In standing and walking, the entire body load rests on this joint. During normal walking, however, it not only bears its own weight, but depending on the gait, often a multiple of the own body weight.

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Thigh and pelvic bones together form the hip joint. The femoral head is located at the upper end of the thigh bone. This spherical head slides in the hip socket from the pelvic bone. Both joint partners are covered with a very smooth, white-blueish cartilage layer. The hip joint is enclosed by the strongest joint capsule of the human body. The hip joint capsule, together with ligaments and muscles, holds the thigh bone and the acetabulum firmly together. The inner skin of the joint capsule produces a special joint fluid that keeps the joint cartilage elastic and at the same time keeps the two bones in the joint at a distance. This “lubrication” ensures a gentle and painless movement of the natural hip.

Die erkrankte Hüfte

Hip arthrosis

 

Causes and symptoms

 

Hip joint arthrosis – also known as coxarthrosis – is a disease of the hip joint that often occurs at an advanced age. It involves wear of the cartilage surface of the acetabulum and femoral head, i.e. the cartilage layer that is supposed to protect the joint is destroyed and can no longer act as a shock absorber. The bones then rub directly against each other, they are worn out and may even deform.

 

What symptoms may occur?

 

  • Pain under stress / morning starting pain
  • Pain at rest / night pain
  • Groin pain
  • Pain in the lumbar spine
  • Hip Pain
  • Movement range of the hip joint is limited
  • Diminished walking distance

 

Main cause of arthrosis

 

The main cause of osteoarthritis is age and general wear and tear of the joints over the years.

 

Further risks

 

  • Osteoporosis (loss of bone)
  • Overstressing or overloading (e.g. overweight)
  • Joint inflammation (e.g. due to rheumatic or metabolic disorders)
  • Accidents or injuries (e.g. fracture of the thigh)
  • Hip dysplasia (in infancy)
Physiotherapy can help relieve pain

What is the best way to treat osteoarthritis?

 

Complete cure of arthrosis is still not possible today. However, medicine offers proven treatment methods that are based on you as a patient and your state of health. Conservative treatment, i.e. without surgery, attempts to alleviate symptoms and improve mobility. If these therapies are unsuccessful, the insertion of an artificial joint helps to restore your quality of life.

 

What does a conservative treatment achieve?

 

There are different possibilities to treat the symptoms of hip arthrosis with conservative therapies. These include, for example:

 

  • Cold and
  • Heat applications
  • Electrotherapeutic treatments
  • Orthopedic shoe inlays
  • Medicines for joint irritation
  • Pain Therapies
  • Radiosynoviorthese diese
  • Physiotherapy
  • Nutritional Supplements
  • Acupuncture

 

What can you do yourself to mitigate the consequences of arthrosis?

 

Discuss with your doctor whether a change in diet and/or weight loss will help your symptoms and the joint. Do light sports that are easy on the joints, such as water gymnastics, by arrangement. Also avoid a “relieving posture” in order to relieve the joint. This usually leads to further complications in the joint and ligaments. Special movement exercises should help you to cope better with everyday life. A professionally supervised physiotherapy can support you in this.

The artificial hip joint

 

When only one surgery helps

 

Only when all conservative options have been exhausted will your doctor talk to you about an operation. The aim is to enable you to enjoy life without pain and with mobility again. The implantation of artificial hip joints has a history of more than 50 years in medicine and is now one of the most common operations. Implants, technologies and methods have been continuously developed since then.

Construction of an artificial hip joint

 

The artificial joint, also known as an endoprosthesis, replaces the head of the femur and the acetabulum – in other words, exactly those parts of the joint that cause the complaints through their wear and tear. All the elements of an artificial hip joint work together, following the example of the natural joint.

Connection to bone

 

Biological anchoring is based on the principle of cementless anchoring. This means that the implant surface is in direct contact with the bone and biological healing / adhesion “osseointegration” takes place. The bone remains active, grows together with the stem and forms a biological unit. The shape and surface of the implants are of decisive importance for cementless anchoring. Stable and permanent anchoring is a basic prerequisite for the life of the artificial joint.

 

In the case of a cemented restoration, this is done with bone cement. The hip stem and, in some cases, the acetabulum are firmly anchored to the bone using a fast-setting plastic (bone cement). This form of anchoring has achieved maximum stability very quickly, shortly after the operation.

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A hybrid restoration is used if cemented anchoring has been selected for one of the components and cementless anchoring for the other component.

 

Your doctor will decide on the choice of the connection to the bone based on your individual bone condition.

The hip surgery

 

The hip joint lies under the hip muscles. The hip joint is enclosed by the strongest joint capsule in the human body. The capsule is exposed and opened as gently as possible. In the next step, the worn joint surfaces and the previous joint head on the thigh are removed and the remaining bone is prepared for the implant. The joint socket is prepared here with a milling machine to accept the artificial socket. Depending on the type of prosthesis used, the socket is either pressed into the bone, screwed or cemented into place. In the case of the femur, a special rasp is used to model the bone so that the implant fits exactly into its bony environment. The stem is inserted either cementless or cemented in. The ball head is then connected to the stem and inserted into the artificial hip socket. The entire operation takes about one hour.

 

The operation at a glance

1. Joint surfaces and joint head are prepared for the implant
2. The cup is inserted into the pelvic bone
3. The stem is anchored in the thigh bone
4. The ball head is placed on the stem
5. The cup insert takes up the ball head

Fast asked questions

What else can I do myself to optimally prepare for the operation?

Good fitness can help you get back on your feet faster. The best way to find out which sport and which exercise is suitable for you is to talk to your doctor. The better you are in shape, the faster your body can cope with the stress of an operation. Losing weight if you are overweight would also be helpful now, as a lower body weight reduces the load on the new joint. Quitting smoking can also be helpful for your faster recovery, so seriously consider quitting smoking. Knowledge relaxes and calms you. Therefore, please feel free to ask your doctor or the staff everything about your stay in hospital. They will be happy to answer your questions about anesthesia, medication and nutrition.

How long does a hip implant last?

Despite its high performance, an artificial joint is never equivalent to a healthy natural joint. In the scientific literature, the average risk for a replacement operation is given as a maximum of 1% per implantation year. Thus, many prostheses even last a lifetime. Causes for premature loosening of the artificial joint are, for example

  • Bone quality
  • Comorbidities
  • accompanying factors such as overweight
  • too much or wrong load
  • Infections
  • Broken bones
  • Pain
What diagnostic procedures are available?

X-ray image (standing)The irradiation of body parts with X-rays is shown in images called x-ray images or radiographs. Magnetic resonance imaging (MRI) MRI is an imaging procedure without exposure to radiation that is used to visualize the structures and functions of tissues and organs. Computer tomography (CT) Computed tomography is a procedure for the layer-by-layer imaging of bone structures based on X-rays. The examination can be performed quickly and is very precise.

Can one react allergic to a prosthesis?

As a rule, admission to hospital takes place the day before the planned operation. Usually your personal data will then be requested and you will be assigned to the ward and room. An anesthesiologist will then discuss the planned anesthesia with you. Today, artificial hip joints are inserted both under general anesthesia and with the help of spinal anesthesia. Here, an anesthetic is injected at the level of the lumbar spine to numb the lower half of the body. In general anesthesia, the patient is put into an artificial sleep. Both the consciousness of the patient and his pain sensation are switched off.

What can I do directly before the operation?

Not only the doctor, but also you can contribute a lot to the success before and after the operation. Sometimes it is just the little things that can make your everyday life easier. If you are well prepared, your recovery after the operation can progress more quickly. You should think about some things and take precautions now.

 

stock up your food supplies, this will save unnecessary purchases. Cook larger quantities and freeze individual meals. Put all items that are frequently used at a convenient height between your hips and shoulders, because in the first few weeks you will be restricted in your freedom of movement.

 

There are a number of aids that can help you in your everyday life after the operation. For example, a long shoehorn, for easier dressing of the shoes or a handle on the shower, for safe getting in and out. Your clinic has a lot of experience with things that can make life easier after the operation. Talk to them calmly and they will certainly be able to give you valuable tips to take home with you.

Is there a checklist for the hospital visit?

Checklist “hospital stay”.

 

  • Medical insurance card (if existing)
  • letter of referral from the referring doctor (if available)
  • Personal medicines
  • Information on known allergies
  • Contact addresses with your telephone numbers
  • Pyjamas/night shirts (unbuttonable)
  • Walking aids/Walking stick
  • Care products (toothbrush, toothpaste, soap etc.)
  • Jogging suit and/or bathrobe
  • X-ray images, examination reports (if available)
  • Sports shoes (if possible with velcro fastening)
  • Long shoe horn
  • Shoulder bag/backpack
  • Some cash
Section

Today, various minimally invasive procedures are used for hip joint implantation. The aim here is to use as little soft tissue as possible and to avoid damaging it. The advantages of a minimally invasive operation are:

 

  • Faster rehabilitation
  • Less pain
  • Little blood loss during surgery
  • No muscle injury or separation
What risks can occur?

In Germany alone, about 210,000 hip prostheses are implanted annually. This makes this operation one of the most well-known treatment methods. As with all operations, however, a hip joint implantation also involves risks.

 

These include, for example:

 

  • Vascular/nerve damage
  • Infections
  • Leg length difference with possibly required compensation of the opposite side
  • Broken bones
  • Thrombosis
  • Calcifications in the musculature
  • Loosening of the implant components
  • Wear and material overload
  • Restricted range of motion
  • Pain
  • Incompatibilities
When do follow-up appointments take place after the operation?

In consultation with your doctor, this should be done twice at 6-month intervals in the first year, then once every two years. Please take your last X-ray and the implant passport with you. Every follow-up check should be entered in the patient passport. This way you always have an overview. The regular check-ups allow possible complications to be detected very early. If severe pain suddenly occurs, the treating physician must be consulted immediately. With your hip endoprosthesis you have a high-quality artificial joint with which you can achieve your desired quality of life again. If you behave correctly and have regular check-ups, you can assume that the joint will have a long life.

Can or should I do sports after the surgery?

Basically no sports in the first 6 months! After that, light sports can be practiced again, in consultation with your doctor. Extreme sports with overstraining of the artificial joint and/or increased risk of falling should be avoided in your own interest. Extreme overloading leads to increased abrasion of the prosthesis and considerably reduces the already high life expectancy of an artificial joint. Finally
this can lead to premature loosening.

 

Recommended sports

 

  • Swimming
  • Riding a bike
  • Nordic Walking
  • Rowing
  • Hiking
  • Gymnastics