Hip Arthroplasty

When the discomfort caused by hip arthrosis can no longer be relieved through conservative measures and when the patient’s quality of life suffers considerably, the time has come to discuss joint replacement surgery (arthroplasty).

This decision is always made on a case-by-case basis and results from the discussion between the treating physician and the patient. The Englishman Sir John Charnley first implanted artificial hip joints about 60 years ago. Numerous improvements and the introduction of new materials in recent decades have led to the situation today, where hip arthroplasty is on a high level and the operation is very reliable in providing freedom from pain and improved functionality for the affected patients. Still, an endoprosthesis does not last forever; depending on the material used and the level of activity, it is calculated that is will last for 12 to 15 years on average. Various kinds of influences, each the subject of ongoing research, affect the durability of the implants. One very crucial aspect is surely the fact that the implanted materials are prone to degeneration and that this is higher the greater the physical activity of the affected patient. It thus appears to be confirmed that an endoprosthesis has the highest level of durability in female patients over 70 years of age and the shortest lifespan in male, active patients under 60 years of age. This observation leads to the recommendation that physical stress and the level of activity of the wearer of an endoprosthesis should be reduced to “normal” walking stress and “light to medium” physical activity.


The Artificial Hip Joint

The artificial hip joint generally consists of 4 different components:

  • the acetabular cup, a metal shell, which is usually made out of a titanium alloy and is offered in various diameters
  • the cup insert (inlay), made of polyethylene, ceramics (Biolox forte or Biolox delta), or metal
  • the ball head, which is available in various stem lengths and made from various materials (metal, Biolox forte, and Biolox delta ceramic)
  • the shaft, which is available both in different materials (surgical steel, titanium) and in very different forms. The surface of the cementless cups and shafts is often coated in addition in order to accelerate the bonding with the bone, which happens when the bone cells grow into the implant.
    The different components of a cementless hip endoprosthesis and their combinability.
    Bild eines künstlichen Hüftgelenks (Hüftendoprothese)

    As a matter of principle, an endoprosthesis can be implanted either in a cementless or cemented way. It is also possible to cement either the cup or the shaft individually and to anchor the other part of the endoprosthesis without cement. Such cases are called hybrid treatment.

    The decision about which type of anchoring and which implant to use is the subject of a thorough discussion between the doctor and the patient. Factors that co-determine this decision include the patient’s age and level of activity, the quality and shape of his or her bones, as well as the underlying disorder leading to the need for joint replacement (rheumatoid arthritis, arthrosis, necrosis of the femoral head). In addition, allergies, general health status, noticeable differences in leg length, and the endoprosthetic systems used in the hospital must be considered when making this decision, which is usually a very individual one.

    Lately, patients have increasingly been expressing their desire to have minimally invasive surgery. We do take these wishes into account, but please be aware that not every shaft is suitable for implantation using such gentle access.


    Minimally Invasive Hip Surgery

    To date, this term has not been defined exactly in hip arthroplasty. Whereas some experts believe that the point is to remove as little bone as possible, i.e., to replace the surface, the majority appears to agree that the extent of the damage to muscles and soft tissue represents the criterion for minimal invasiveness. As a direct consequence, accelerated rehabilitation can be deduced and expected from reduced damage of the soft tissues. As nice as a short incision in the skin may be, by itself it is not suitable as a criterion for the invasiveness of an operation.

    Minimally invasive hip surgery in arthroplasty thus primarily describes the access to the joint, which leads through two neighboring muscles and does not damage these during the procedure (so-called intermuscular access). When surgery is performed in this way and suitable implants and instruments are used, it is indeed possible to realize skin incisions of less than 10 cm, and a surprisingly fast course of rehabilitation is common. This type of hip surgery is not suitable to the same degree for all patients. The primary goal of hip replacement is always to anchor the implant in the best possible way and to implant it so well that it has the longest possible lifespan. It is thus absolutely crucial that under no circumstances may such minimally invasive access lead to making false compromises and thus to jeopardizing the actual goals of joint replacement.

    We have been working with minimally invasive hip access since 2007 with ever increasing frequency in patients with suitable body structure and bone shape. In the case of difficult anatomical conditions or particular bone conditions, conventional hip access is the better alternative – particularly in terms of the durability of the implanted prosthesis.

    All so-called conventional hip access operations are performed by us. The decision about whether lateral or posterior access is used is again made on an individual basis and depends on the given anatomical conditions and the type of implant to be used. 

    Navigation in Hip Arthroplasty

    In knee arthroplasty the use of navigation has been standard for us since 2007. Due to the favorable experience we have had with this method, we have also started using navigation in hip arthroplasty. The results to date are very promising and we currently see the following advantages of using hip navigation compared to conventionally implanted joints:

    • Improvement of mobility with concurrent reduced dislocation risk
    • Control of leg length and of the distance between the center of the hip and the vertical body axis
    • Improved durability through best possible positioning of cup and shaft in relation to each other
    • Seamless documentation of the course of the surgery
    • Support for problematic decisions during surgery

    Which implants do we use in hip surgery in Landstuhl?

    Since 2007, we have been collaborating mainly with the company Amplitude in the field  of arthroplasty. Almost all knee endoprostheses and three quarters of the hip endoprostheses that we implant are made by this manufacturer.

    More than 90% of the implant operations are performed without bone cement, that is, cementless. For special situations, for instance in the case of soft, osteoporotic bones, it may be necessary to cement one or both implants.

     

     

    Contact Person

    • Dr. Dieter Wrede

      Chief Senior Physician

      Specialist in Orthopedics, Trauma Surgery, Surgery

      Send email

      06371 84-2701

    • Viktor Balzer

      Senior Physician

      Specialist in Orthopedics, Trauma Surgery

      Send email

      06371 84-2701