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What is an Artificial Hip? - The Orthopaedic Research Institute

What is an Artificial Hip? – The Orthopaedic Research Institute

What is an Artificial Hip? – The Orthopaedic Research Institute

Prof. Dr. Hans Gollwitzer is Senior Physician for Hip Surgery and Knee Arthroplasty at the ATOS Clinic Munich and as Professor at the Technical University of Munich

Barbara Reisen: “Prof. Gollwitzer, every year approximately 200,000 artificial hip joints are used in German operating theaters. When is an endoprosthesis unavoidable for the patient? “

Prof. Dr. Gollwitzer: “An artificial hip joint is usually necessary because of advanced osteoarthritis. In elderly patients, joint replacement may also be required in a femoral neck fracture. An artificial hip joint is usually recommended if the pain can not be sufficiently alleviated by non-surgical treatment. Surgery is also often indicated when long-term use of painkillers becomes necessary. Regular use of painkillers can lead to organ damage in the medium term. ”

Barbara Reisen: “Should one decide on an operation as soon as possible or should they hesitate for as long as possible?”

Prof. Dr. Gollwitzer: “Artificial hip joints have a limited shelf life. Therefore, the natural joint should be preserved as long as possible. Earlier surgery is useful if osteoarthritis leads to bone damage that complicates subsequent implant anchoring, or if hip mobility is so limited that adjacent joints such as the knee and spine are also damaged. If the symptoms can not be managed by means of conservative therapy, then it also makes little sense to wait a long time. ”

Barbara Reisen: “How is an implant for an artificial hip joint fixed in the body?”

Prof. Dr. Gollwitzer: “In the classic hip endoprosthesis, an artificial pan is inserted into the pelvis and a stem is inserted into the femur. The pan is introduced without cement in most cases, and either stably clamped (so-called. Press-fit anchoring) or screwed. Depending on the quality of the bone, the stalk is either clamped or glued in place with bone cement (polymethyl methacrylate). A cementing of the pan is also possible with poor bone quality. ”

Barbara Reisen: “And which of these forms of processing is more compatible with the patient?”

Prof. Dr. Gollwitzer: “The current studies show no significant difference in the durability of cementless and cemented hip stems. In general, the loosening rate is slightly greater in very young patients because of the higher stress, and in older patients the durability of cemented pedicles is better. ”

Barbara Reisen: “From which material can an endoprosthesis be made at all?”

Prof. Dr. Gollwitzer: “The modern acetabulum and stems are usually made of a titanium alloy, as it has proven to be highly compatible in bone. There are numerous variants in the so-called sliding partners, ie the prosthesis head placed on the pedicle and the socket insert. A distinction is made here between the following material combinations (prosthesis head – socket insert): so-called hard-hard pairings (ceramic-ceramic or metal-metal) and hard-soft pairings (ceramic-polyethylene or metal-polyethylene). ”

Barbara Reisen: “What would interest many of our readers at this point, of course, are there differences in tolerability for the patient?”

Prof. Dr. Gollwitzer: “Indeed. The combinations differ on the one hand in the wear resistance, and on the other hand in the compatibility of the abrasive particles. Although metal-metal combinations show only a small volume of abrasion, there are particularly many very small particles which have a high biological surface and activity and can therefore lead to pronounced incompatibility reactions. This phenomenon was recently present in the media due to high failure rates of so-called cap prosthesis.

The most favorable Abriebeigenschaften shows the combination of ceramic-ceramic, but with the disadvantage of a minimized risk of breakage, especially the pan insert. In Germany, a socket insert made of polyethylene and a prosthetic head made of ceramic are therefore used in most cases. ”

Barbara Reisen: “In recent years, the term ‘minimal invasive’ intervention is increasingly being heard in hip surgery. What exactly is meant by that? “

Prof. Dr. Gollwitzer: “A true definition for” minimally invasive “unfortunately does not exist, but often a cutting length of less than 10cm is described as a prerequisite. There are massive differences in the various “minimally invasive” approaches, as far as the overview and above all the damage or severing of deep muscles and tendons is concerned. Many of these approaches require the at least partial severance or notching of muscles and tendons, which can lead to permanent discomfort after surgery. A truly minimally invasive approach – such as the AMIS technique – should completely protect all muscles and nerves while providing a good overview of correct implant positioning. ”

Barbara Reisen: “And how can the layman imagine such an operation in practice?”

Prof. Dr. Gollwitzer: “We carry out the operation according to the so-called AMIS method. The incision is 8-10cm long. The deeper layers and muscles are then pushed apart only dull, which spares all muscles and tendons. A big advantage of AMIS access is that it is from the front and the adjacent muscles are all long muscles that can be kept well apart and thus provide a good overview. The lateral and posterior approaches, however, all border on the short hip muscles, which tear much easier. After opening the hip capsule, the femoral head is severed and the hip prosthesis is inserted. Finally, we suture the capsule as protection against dislocation and the wound is closed again. ”

Barbara Reisen: “What role does this surgical procedure play in minimizing blood loss and postoperative convalescence?”

Prof. Dr. Gollwitzer: “The surgical technique has a tremendous impact on convalescence after surgery, on the complication rate, but also on long-term results. The tissue-sparing AMIS technique has made complications such as the need for blood transfusion or dislocation a rarity. Patients are more mobile again after surgery, the need for painkillers has been proven to be significantly lower and chronic pain, such as that caused by tendon damage, can be avoided. ”

Barbara Reisen: “What does modern joint-preserving hip surgery mean for the patient?”

Prof. Dr. Gollwitzer: “The modern joint-preserving hip surgery is an important building block in the treatment of hip joint diseases. Since the majority of hip arthrosis has a mechanical cause, such as bruising by bony attachments to the femoral head and acetabulum, a timely joint preserving operation can arrest arthritis development. Such operations can often be performed using keyhole surgery. Our specialization in hip surgery and the treatment of hip diseases makes it possible to offer our patients an individually tailored therapy depending on the stage of the arthrosis. ”

Barbara Reisen: “Prof. Gollwitzer, last but not least the question: how ‘safe’ is such a hip operation today? “

Prof. Dr. Gollwitzer: “Every operation involves risks. However, due to the specialization and routine of the surgeon, the complication rate can be significantly minimized. Hip arthroscopy is a fairly safe procedure with a complication rate of less than 5%, with the rate of serious complications well below 1%. Also in total hip arthroplasty, the proportion of satisfied patients is approx. 95%. The hip replacement was named the most successful operation of the past century due to this high success rate. ”

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