The orthopedic department of the Clinical Center of Friedrichshafen performs all kinds of hip replacement surgeries. Head of the department is an experienced surgeon Prof. E. Winter, whose main focus lies in hip, knee and shoulder replacements. More and more people are beginning to suffer from hip disorders, which result in hip joint pain and serious symptoms and can limit the mobility considerably.
Conservative treatment may not be sufficient if the osteoarthritis is advanced or if the joint cartilage is severely damaged. Under these circumstances, an artificial joint offers a new mobile life. It is therefore no wonder that people are resorting to surgery and that the number of hip replacement procedures has risen steadily over the last few years. This replacement procedure has become standard in orthopaedic surgery, and is performed almost 200,000 times annually in Germany.
Diseases that can be conquered by the joint replacement are, for example, inflammations of the joint and age-related wear. However, injuries and tumours can also be treated by means of hip replacement surgery. For better understanding of the causes of the disease and choosing a better treatmen option our joint specialists start with diagnosis.
The layer of cartilage isn’t directly visible on an X-ray image. Only a dark gap can be seen between the femoral head and the socket hip. Your doctor can recognize a healthy joint by the joint (articular) gap being smooth and evenly formed. A very narrow or absent joint gap is a sign of the breakdown of cartilage, called osteoarthritis. Osteoarthritis of the hip joint cannot be healed. However, conservative treatment methods can contribute to pain relief and prevent or delay the need for surgery:
Besides the treatment of injuries and orthopaedic diseases of all kinds, endoprosthetic hip and knee replacement surgery is one of the main focuses of our clinic in Germany. We perform over 700 hip and knee replacement operations and corrections of these joints annually. In the Clinic for Orthopaedics and Trauma Surgery, we perform the entire spectrum of endoprosthetic (joint replacement) surgery and each of them is preceded by choosing a type of endoprosthesis.
A modern hip endoprosthesis improves your quality of life and gives you more mobility in your free time, during exercise, ordinary daily routines, and in your professional life. The insertion of artificial joints is one of the most successful and most economical treatment methods in the history of modern medicine. As a rule, the surgery enables complete restoration of mobility. Through the use of tried and tested implants combined with minimally invasive surgery techniques, we are able to achieve a very high standard of treatment and patient satisfaction at our clinic in Germany.
The hip endoprosthesis is shaped to resemble the natural hip joint. It replaces parts of the diseased joint: the femoral head and the hip socket. Thanks to intensive research efforts, it has become possible to replace diseased parts of a joint while conserving as much bone as possible. There is a distinction between surface replacement, primary intervention, and revision.
In older patients where the condition of the joint is suitable and in young patients with the right bone quality, the neck of the femur can be retained so that the surgeons have natural bone to work with should the prosthetic hip need to be replaced at a later stage. Whether the condition of your bones meets these requirements or not must be discussed within the framework of a personal consultation and an examination.
In surface replacement, the femoral head is not removed, but rather capped using a metal cap. The cap is fixed by a thin pin a small amount of bone cement. The hip cup is also made of metal. The implant allows a wide range of motion.
The advantages of the Mc Minn joint replacement technique
The surface prosthesis is a more gentle method that avoids trauma of the intact articular tissues. With this technique, first used in Germany in 1997, the surgeon manages to keep the head of the joint and to avoid the extensive removal of the articular surface. This minimally invasive surgery is indicated primarily for young patients. During the research it has been proved that the ion metals (cobalt and chromium) don’t get into the body and can in no way affect the patient's health status.
In primary intervention, the diseased parts of the joint are replaced by an artificial joint that consist of a femoral stem and hip cup. The femoral stem is cemented or pressed into femur, while the hip cup is cemented, screwed or pressed into the pelvis. A ball-shaped head that can move within the hip cup is placed on the femoral stem. It is also possible to use larger ball-shaped heads that offer a larger range of motion and reduce the risk of dislocation (luxation).
The lifetime of a modern hip joint is already more than 10 years. After this time a revision operation may be necessary. Such operations have also become routine. During the revision, the artificial hip joint is either partly or fully replaced by a new artificial hip joint.
The lifetime and functional performance of joint implants depend on a variety of factors: on the one hand the materials of the slide pairings, and on the other hand the lifestyle and general health of the patient (e.g. physical activity, bone characteristics, body weight and the age of the patient, as well as concomitant diseases, such as chronic polyarthritis).
Endoprostheses have to work properly for a long time. High demands are therefore made of the materials used to ensure long-lasting and trouble-free performance of implants. Their structure must keep to a minimum the inevitable wear and tear caused by friction. Moreover, the materials must be corrosio resistant and biocompatible and provide for good adhesion to the surrounding bone by means of growth processes. The majority of modern femoral stems and hip cups are covered with particularly biocompatible titanium or cobalt-chromium alloys. The femoral stems are hot-forged to attain the required strength of the material.
The slide pairings include femoral heads made of ceramic or cobalt-chromium alloys, combined with hip insert made of polyethylene, ceramics or cobalt-chromium alloys (Figs. 1-3).
Besides standard replacement surgery, we also offer modular, sectional and custom-made prosthetics, which, with the aid of X-Ray images and CT datasets, are constructed especially for individual patients. The anchoring of the implants during surgery can be done either according to cemented or cement-free technology, depending on the individual case. If necessary, we perform the procedure with the support of highly modern computer navigation systems. Follow-up treatment after hip or knee replacement surgery is performed by an interdisciplinary team of physicians, nursing staff and physiotherapists, according to a clearly defined treatment plan.
In this hip replacement procedure, the titanium components of the prosthesis are anchored directly onto the bone during surgery. The hip cup is screwed or pressed into the pelvic bone and the femoral stem is pressed into the femur. After preparation with special instruments, the prosthesis is clamped into the bone, where it “heals” into the bone.
The bone-friendly materials of the components have a rough surface that promotes the adhesion to the surrounding bone tissue by osseointegration. Having a good bone quality promotes rapid adhesion. Modern procedures generally ensure that the leg can be exposed to stress, which was not the case many years ago.
If the bone is too weak to provide sufficient stability for a cement-free prosthesis, due to the age of the patient or as a result of specific diseases, the prosthesis will be anchored with so-called bone cement (a synthetic material that has been tried and tested for decades).
The quick-hardening bone cement (shown in blue), fixes the femoral stem and the hip cup to the femur and the pelvis, respectively. In addition, the bone is also stabilised from the inside in order to reduce the risk of a break in the immediate vicinity of the prosthesis. A cemented hip joint can be exposed to a full load soon after this procedure. In so-called hybrid hip replacement surgery, cemented and cement-free prosthetics are combined in order to achieve the ideal treatment for the patient.
This combination unites the advantages of the two procedures. The hip cup is pressed or screwed into pelvis without the use of cement, whereas the femoral stem is cemented into the femur.
In every case, the goal of joint replacement surgery is that after successful rehabilitation, the patient regains his (almost) normal, symptom-free life once again.
The major priority of the German specialists is accurate implantation of an artificial joint. The traditional technique involves the installation of an artificial joint using mechanical tools. However, according to numerous scientific studies, traditional techniques often lead to inaccurate implantation of the prosthesis.
To improve the accuracy, a special computer-navigation is system is applied during the hip replacement, Every step of the operation can be cross-checked. Only if the the computer reports the precise execution of the current surgical procedures, the experts can proceed with the next step. At the end of surgery, the surgeon achieves the exact position of the implant and symmetrical stabilization of ligamentous apparatus. The navigation device also documents the process of surgery.
According to the latest clinical analysis, the introduction of a navigation system can not only reduce the risk of complications, but also helps to improve the functionality of the joint. In addition, there is a low level of blood loss during the computer-assisted hip replacement surgery.
The implantation of a hip prosthesis has become a common operation at orthopedic joint surgery centers. A well-organized team ensures that you receive optimal care and management. The individual steps of the operation follow a well-established procedure.
Surgical replacement of hip can be performed two ways: either traditionally, or with the help of so-called minimal invasion technique. These procedures mainly differ by the size of incisions made.
Your anesthetist will advise you of the possible risks and various methods of anesthesia. Partial anesthesia means that the anesthetist injects a local anesthetic near a large nerve to render the body region involved in the operation numb and insensitive to pain. You will be conscious during the entire operation.
Full anesthesia means that you will be given medication on the day of operation that genty sends you sleep within a few seconds. You will be unconscious and unable to feel any pain. Breathing and circulation will be monitored continuously during the operation. You will receive oxygen through an oxygen mask. The implantation of an artificial hip joint is rarely associated with complications. However, in any operation of this type, there is an inherent risk of bruising, infections, thrombosis or embolism that needs to be noted. Your doctor will advise you of these risks in detail before the operation.
The implantation of the new joint takes, on average, approximately one or two hours. During traditional operation a doctor makes an incision on patient’s hip and removes the muscles attached to the higher part of the thighbone to see the hip joint. Then the ball potion of the joint is extracted by sawing the thighbone (special saws are used to perform this action). An artificial joint is joined to the thighbone with the help of cement or some similar material.
Next step, the exterior of the hipbone is treated: all ruined cartilage is removed, and parts for replacement are attached to the hipbone. To let fluid out, a drain may be put in. After that, the surgeon attaches muscles again and sutures the incision.
During the operation, a patient can experience serious blood loss, which makes a blood transfusion necessary. Prior the procedure, it is recommended to donate your blood.
Although about 80% of hip replacement surgeries are done by the above described way (traditional surgery), but recently, many doctors started practicing an approach that presupposes minimal invasion. In this case, 1-2 incisions up to 5” long are made instead of one long cut. Muscles and soft tissues situated right under the skin do not need to be cut, but can simply be pushed aside. Since the wound smaller, there is less strain for body and the healing process may be accelerated.
Apart from the conventional surgical methods, the minimally invasive techniques preserve the soft tissues particularly well. This way, blood loss is not so severe, pain after surgery is easier to tolerate, scar appearance reduced, and recovery time becomes shorter. But it is crucial to have the operation performed by an experienced surgeon. If a specialist is not skilled enough in this technique, the outcomes from a minimal invasion surgery can be more serious than in cases with usual approach.
The individual steps of the operation are similar whether you receive the cemented or the cement-free hip prosthesis. An incision in the skin is made to gain access to the diseased hip joint capsule, which is then opened in order to expose the hip joint inside. The diseased femoral head is cut off at the femoral neck.
The surfaces of the cartilage of the hip socket, destroyed by the osteoarthritis, are then worked on. The hip socket has to be prepared so that the new, artificial cup fits exactly in place allowing it to be pressed or screwed into place.
The medullar space of the femur is opened. The bone is made to fit the size of the stem of the endoprosthesis using specialized rasps. The stem can then be inserted either with or without the use of bone cement.
A ball-shaped head is then placed on the femoral stem. Finally the surgeon thoroughly checks the new joint for mobility and function, before closing the wound and applying a compression bandage.
In order to minimize the pain you experience, you will receive pain-killing medication. Any exudations from the wound will be removed using drainage tubes to ensure that no major bruises are formed. After one or two days the drainage tubes will be removed and the surgical wound will be checked regularly. The stitches will be taken out after ten to twelve days. If the wound has healed well, you may already start mobilizing, for example, in the rehabilitation pool.
Compression stocking and blood-thinning drugs will be used to protect you from thrombosis. The stockings should be used until the leg can be fully exposed to strain again. Until then, the stockings should only be taken off when you take a bath or shower.
Over the years, an implanted prosthetic hip is exposed to many millions of alternating load movements. This can lead to wearing down of the prosthesis or even to weakening of the anchor-points of the prosthesis, which in turn leads to loosening of the prosthetic hip. In such a case, the prosthetic hip needs replacement. Due to the condition of the soft tissue and the bone, this procedure is often extremely demanding from a technical perspective. This makes it absolutely essential for clinics, such as our clinic in Germany, to offer a broad spectrum of treatment options and special implants, in order to be in a position to solve the individual problems of the various patients. Besides these factors, the experience of the surgeon also has a profound effect on the final result of the hip replacement surgery.
The cost efficiency of the health procedures and health economic aspects are steadily gaining importance in our health system. Despite this, patients should continue to receive high-quality services. The following aspects allow a modern health system to meet these requirements: minimally invasive surgical techniques reduce the length of stay in hospital and rehabilitation time, large ball-shaped heads reduce the dislocation risk; long-lasting high-quality materials improve the lifetime of endoprostheses and thus render revision operations unnecessary in many cases.
The goal at our clinic in Germany is to guarantee the best possible medical treatment for each patient. We would be pleased to discuss questions regarding endoprosthetic hip replacement surgery during our consulting hours. Please call and make an appointment.
Comments and questions