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Hip arthrosis

Cause

A common cause of hip pain is a wear-related disease of the joint called coxarthrosis. In this case, the protective articular cartilage between the acetabulum in the pelvic bone and the femoral head on the thigh shaft is damaged. If the cartilage layer tears in places and becomes rough, the pressure on the bones increases during movement.

In everyday life, hip osteoarthritis is often manifested by pain on starting, buckling when walking for long periods, pain when descending steps, and pain in the groin of the affected side of the joint.

If the wear and tear of the hip joint is far advanced, an artificial joint replacement can reduce discomfort.

Diagnostics

The basis for successful treatment of the painful joint is a precise examination of the patient. For this purpose, the doctors of orthopedics first ask for details about the course of the disease, previous illnesses and lifestyle habits in an interview.

The next step is a physical examination. During this examination, the doctor looks at the patient's gait and posture. This makes it possible to identify malpositions and relieving postures that lead to complaints. The mobility of the joints is also checked in this context. Depending on the movement restrictions, this can already indicate the severity of the hip arthrosis.

In addition, various imaging procedures provide information about the joint situation of the affected person. These include X-ray images. If the distance between the acetabulum and the femoral head is narrowed, it can be concluded that the articular cartilage between the bones is damaged or worn away. An ultrasound examination (sonography) can be used to visualize the soft tissues such as muscles, ligaments and synovial fluid. Magnetic resonance imaging, on the other hand, depicts ligaments, muscles and also the cartilage.

Treatment

If the suspicion of an advanced hip arthrosis is confirmed, the treating physician selects an implant that is suitable for the patient. At Maria-Hilf-Krankenhaus, a variety of prosthesis types are used that are adapted to individual factors. All selections are usually inserted minimally invasively using the AMIS surgical technique. This means that muscles and tendons are not cut, but merely pushed aside. For patients, this has the advantage of significantly shortening the recovery period and leaving cosmetically inconspicuous scars. In addition, a distinction can be made between different options for anchoring the prosthesis.

Cementless prosthesis
A cementless prosthesis is particularly suitable for patients between 60 and 80 years of age with a healthy bone metabolism. In this case, the damaged acetabulum and femoral head are artificially replicated and pressed into the bone. As the healthy bone tissue grows to adhere to the prosthesis over time, a strong and permanent unit is created. Patients can put full weight on the joint immediately after surgery.

Cemented prosthesis
Cemented prosthesis uses a special, fast-hardening bone cement to bond the artificial joint to the bone. One advantage of this type of fixation is that it provides primary stability even in weak bone. This type of fixation is particularly suitable for patients whose bone structure shows damage, for example due to osteoporosis.

Hybrid prosthesis
Hybrid prosthesis refers to a combination of cementless and cemented implant. In this case, the socket is usually fixed without cement, while the prosthesis stem is anchored in the femur with cement.

In order to contribute to improving the quality of endoprostheses implanted throughout Germany, we participate in the Endoprosthesis Register Germany (EPRD). By transmitting anonymized information on implants used, surgical procedures and surgeons, we are helping to build up a long-term database on implanted artificial joints. This will be used to assess the quality of the products, ensure the treatment outcome and reduce the number of replacement operations.

Postoperative care

Thanks to the gentle surgical procedures used by the orthopedics team at Maria-Hilf-Krankenhaus, patients can begin their first bedside mobility exercises on the day of their operation. The experienced physiotherapists support them in this.

From the first mobilization, patients can and should put full weight on the treated joint. Forearm crutches provide patients with additional security during the first four weeks after surgery.

Replacement surgery

Treating discomfort due to an existing implant is a major challenge. If a hip joint endoprosthesis has to be changed due to infections, fractures or loosening, careful diagnostics and preparation as well as precise therapy planning are necessary. Due to close interdisciplinary cooperation with the other specialist departments of the Maria-Hilf Hospital, as well as with various special laboratories, it is also possible for the orthopedists to achieve an optimal result here using the most modern revision endoprostheses.

Knee arthrosis

Cause

Knee pain is often caused by wear and tear, so-called gonarthrosis. This can be caused by accidents, injuries, malpositions or age-related wear and tear. The joint cartilage, which protects the joint partners from friction and serves as a shock absorber for movements, is damaged. As a result, smooth movement is no longer possible.

Knee osteoarthritis is initially manifested by "start-up difficulties", i.e. pain at the beginning of a walking movement. Depending on the severity of the joint damage, there is also constant pain on exertion and, in the case of advanced arthrosis, pain at rest. This in turn leads to movement restrictions that reduce the quality of life of those affected.

If conservative measures such as painkilling and anti-inflammatory drugs no longer promise success, artificial replacement of the affected joint is the method of choice. This can restore the natural range of motion of the joint and relieve the pain in the long term.

Diagnostics

In order to get an idea of the joint situation in advance of surgery and to be able to adapt the joint replacement precisely to the patient's anatomy, various examinations are performed. These include exact leg measurements with images of the entire leg. This is necessary to be able to plan any necessary axis corrections and to determine the exact size of the implant.

Treatment

If the examinations show that artificial replacement of the painful knee is necessary, a choice can be made between three different types of prosthesis: partial joint replacement, uncoupled surface replacement and axis-guided prosthesis.

 

Partial joint replacement

A partial joint replacement, also called a sled prosthesis, is used when only part of the joint is worn. In this case, the affected bone is crowned and the patient's natural anatomy is recreated. Since the goal of orthopedics is to support the joint with as little material as necessary, the sled prosthesis is a good solution if the quality of the bone substance allows such a replacement.

Uncoupled surface replacement

When more than one part of the joint is damaged, a total surface replacement is used. Similar to a partial joint replacement, all the bones that meet in the joint are crowned and the natural shape is restored. This type of prosthesis can be used if the patient's ligamentous structures are intact and can stabilize the knee without additional support.


Axis-guiding joint replacement

If the ligaments that guide movement in the knee joint are severely damaged so that they lose their stabilizing function, this can lead to malpositioning of the legs (knock knees or bow legs). In this case, an axis-guiding prosthesis promises to improve the joint situation. This type of prosthesis is an extension of the crowned surface replacement. In addition to the natural bone shape, the stabilizing ligaments are also reconstructed.

The joint surfaces are usually made of a well-tolerated metal such as titanium. The sliding surface between the joint partners is equipped with highly resilient plastic to mimic the effect of the articular cartilage as a natural "shock absorber". In contrast to the hip and shoulder, the prostheses are fixed to the upper or lower leg bones exclusively with special bone cement. The reason for this is the anatomical peculiarity and the heavy load on the joint in everyday life.

Using computer-aided, preoperative planning, which is based on the patient's individual, anatomical conditions, as well as a gentle surgical technique, the orthopedics team can achieve an ideal surgical result. The prostheses are also characterized by a long service life. On average, they can remain in the joint for more than fifteen years without loosening.

Patient safety is the top priority during every operation. In order to prevent infections, all patients who are scheduled for endoprosthetic joint replacement receive a set for conditioning the skin and mucous membranes as part of the preoperative preparation. This can significantly reduce the risk of postoperative infection.

To improve the quality of endoprostheses implanted throughout Germany, we also participate in the Endoprostheses Register Germany (EPRD). By transmitting anonymized information on used implants, surgical procedures and surgeons, we are helping to build up a long-term database on implanted artificial joints. This will be used to assess the quality of the products, ensure the treatment outcome and reduce the number of replacement operations.

Postoperative Care

In order to accompany the effect of the operation in the best possible way in the aftermath, mobilization by a physiotherapist takes place already on the first day after the operation. The exercises applied can be performed directly under full load and with free range of motion of the joint. In addition to mobilization exercises such as walking on forearm crutches under full load as well as stair climbing and special strength exercises, passive motion therapy using a motorized motion splint is also part of the postoperative treatment.

Due to minimally invasive, tissue-conserving surgical techniques and the associated minimal post-operative bleeding, we can completely dispense with the use of wound drains. This also leads to the earliest possible mobility and reduces the postoperative risk of infection.

Physiotherapeutic treatment in the hospital is followed by a stay of several weeks in a rehabilitation clinic. After about four weeks, completely free walking without forearm crutches is possible.
 

Replacement surgery

The treatment of complaints due to an existing implant is a major challenge. If a knee joint endoprosthesis has to be replaced due to infections, fractures or loosening, careful diagnostics and preparation as well as precise therapy planning are necessary. Due to close interdisciplinary cooperation with the other specialist departments of the Maria-Hilf-Krankenhaus as well as with various special laboratories, it is also possible for the orthopedists to achieve an optimal result here using the most modern revision endoprostheses.

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