Hip prosthesis

Barely anyone likes to go to hospital to be operated on. However, sometimes, surgery can lead to a happier life. Most patients can work without pain after the implantation of a hip prosthesis. Here you can read about the opportunities and risks of such an operation in Germany.

When is a hip prosthesis necessary?

Like all large joints, the hip joint is covered with a cartilage layer. The cartilage makes movement free of pain possible because it cushions bumps and pressure. However, if the joint cartilage is extremely worn-out, a hip prosthesis (endoprosthesis) is necessary.

Often, hip arthritis, the degeneration of the joint, is the cause for joint wear and the pain involved while walking. A hip prosthesis can also be necessary in the case of avascular necrosis or after a femoral neck fracture. In any case, a second opinion of a competent doctor should be obtained before the operation. There may be alternative treatments such as physiotherapy or drug treatment which you haven’t tried yet.

Which hip prostheses are the best?

There is only a relative answer to this easy question: It depends. Here are two examples as an illustration:

Let’s suppose that a 55-year-old man needs an artificial hip. He suffers from severely limited mobility. Working overhead in an assembly hall for decades permanently damaged his hip.

An orthopedist would recommend the implantation of a cement-free surface replacement prosthesis. The reason: The man’s life expectancy is above the period of wearing of the hip prosthesis, which is usually 15 to 20 years. This makes a later replacement of prosthesis probable. For the cement-free surface replacement prosthesis, the femoral neck and the femoral head are preserved. Like this, the whole femoral bone can be used for the anchoring of the hip prosthesis in the case of a later revision operation.

A second example: An 81-year-old patient suffers from a stiff hip due to hip arthritis. The wear of the joint cartilage has already progressed so far that she cannot move without pain anymore.

After measuring the bone density and examining the bone metabolism, the orthopedist discovered that the bone isn’t vital anymore. Therefore, he recommends a cemented prosthesis to the patient. The prosthetic socket is fixed in the long bone with bone cement. The disadvantage: If the prosthesis needs to be replaced in 15 or 20 years, the plastic components are hard to remove and the surgery can only be performed by professional orthopedists. The advantage: Because the cement has cured directly after the operation, you can put full weight on the prosthesis on the first day after surgery. Older patients benefit especially from the short rehabilitation phase.

Generally, a distinction is made between:

  • cemented prostheses
  • cement-free prostheses
  •  hybrid prostheses (combination of cement-free and cemented prosthesis)

Preparation for the operation

You should begin to engage in physical activity at least two to three weeks before surgery. Like this, the circulation of the tissue is stimulated, which supports wound healing without complications. Gentle activities such as riding the bicycle or aqua jogging are some good possibilities.

In addition, doctors recommend to avoid alcohol and nicotine and to eat less candy and carbohydrates. Food rich in nutrients, vitamins and protein are a good idea.

To decide on which type of prosthesis and anchoring is the best for you, you will be physically examined thoroughly. Also, your bone density will be measured. The doctor performs a spinal column measurement and determines the length of the leg, in order to be able to ideally fit the prosthesis later.

When all the preliminary examinations are done, the doctor creates a computer-aided plan drawing of your prosthesis with the help of the x-ray images. This plan drawing serves as an orientation during the surgery. At this point of time, you can also obtain a second opinion. Is the planned prosthesis the best for you? A clever doctor knows a lot, two clever doctors know more. It’s about your health!

Classic vs. minimally invasive surgery

An artificial hip can be implanted in different ways. A distinction is made between the classic and the minimally invasive surgical method.

During the classic hip surgery, the surgeon makes a cut on the side or the back of the thigh. Then, he cuts through parts of the femoral musculature and the tendons to get access to the hip bone. Now, he can remove the pathological bone material and insert the implant. Because several muscles are cut through, the rehabilitation phase is longer after the classic hip surgery than after a minimally invasive intervention.

For the minimally invasive surgery, also called keyhole surgery, the surgeon needs  special instruments and tools which are inserted through small skin incisions. The surgeon operates through the muscles and tendons without damaging them. Like this, the lengthy healing of the musculature is omitted. As this method demands a high level of experience, it is recommended to choose a hospital that often performs the implantation of an artificial hip and where the doctors have the corresponding experience.

A minimally invasive surgery isn’t possible for every patient. It isn’t recommended for too muscular or adipose patients. In the long-term, the classic and the minimally-invasive surgery are equal. After no later than one year, there is no difference between the two interventions.

The AMIS approach

A surgical method which is highly requested by patients is the AMIS approach. The abbreviation AMIS stands for “Anterior Minimally Invasive Surgery”. The surgical access to the hip joint is obtained from the front, not from the side or the back. Just like the minimally invasive surgical method, in the AMIS approach, the surgeon works through a natural gap in the muscles without cutting through muscles and tendons. However, he operates just on the border between two nerve supply areas, which is why it is almost impossible not to damage any nerve branches.

Studies show good results after surgery using the AMID approach. That’s why this process is recommendable. Of course, a precondition is that the surgeon has a high level of experience and that surgery is possible. For some severe distortions of the joint due to congenital malformations of the hip, a different surgical access to the joint may for example be necessary.

What happens after surgery?

Often, physiotherapy starts on the first day after the hip surgery in hospital. Most patients feel better quickly, so that they can already take a shower on their own after a few days. After seven to ten days, the external wound healing is usually completed, so the doctor removes the stitches and discharges the patient from hospital.

The subsequent rehabilitation can take place on an in-patient or out-patient basis. It is important that you choose a rehab clinic that is specialized in orthopedics. During the rehabilitation, you learn about behavior rules that decrease the risk of complications and stimulate muscle building with suitable exercises.

Hip surgeries in Germany in 2019

The duration of the rehabilitation phase differs from patient to patient. You shouldn’t lift heavy loads immediately after surgery and use the banisters when walking up and down stairs. Other behaviors that could damage the new hip joint should also be avoided, such as a deep seating position on the sofa, crossing the legs or turning the upper body without moving the legs. The treating doctor in the clinic will give you extensive information on what to pay attention to.

In total, it can take up to one year to get used to the hip prothesis. During this time, you can have unfamiliar sensations, sounds and a sensitivity to changes in the weather in the area of the hip. Depending on your job and the surgical method, you will be able to get back to work after two to three months.

Living with a hip prosthesis

Nine out of ten people are content with their artificial hip joint in the long term. The pain disappears, the function of the joint gets better and pain-free movement is possible again. However, success is not guaranteed. About 10 percent of the people who had surgery are still in pain when walking.

The durability of a prosthesis is between 15 and 20 years – however, many patients wear the hip prosthesis even longer. If the joint head loosens because the bone structure changes for example, the prosthesis has to be replaced.

In consultation with your doctor, you can do sports with an artificial hip. It is recommended to choose a discipline which is easy on the joints, such as cycling, swimming or hiking. But there are also other examples: One year after the implantation of two artificial hips, Heidi Rauch put on her skis and rushed down the ski slope. In this article, she talks about how she experienced the surgery and the time afterwards.