Synonyms in a broader sense
- Artificial hip joint
- Total hip joint endoprosthesis (HTEP or HTE)
- Hip joint prosthesis
- Total Hip Endoprosthesis
Definition
A total hip joint endoprosthesis is an artificial hip joint. The artificial hip joint consists of the same parts as the human hip joint. During the prosthesis implantation, the socket of the pelvis is replaced by an “artificial” one. The neck of the femur and the femoral head is replaced by the prosthesis part of the femur (stem) with the “artificial head” sitting on it.
Complications
Which possible complications can there be? Complications are always dependent on individual components and events. Within the framework of a hip prosthesis implantation, general, but also so-called specific complications can occur.
While the general complications can occur during all major operations, the specific complications include those that can occur as typical complications during hip joint surgery. The “typical” general complications include, for example, the possibility of blood clots forming, thus the possibility of a thrombosis, which under certain circumstances can lead to an embolism. Functional disturbances in the area of the heart, the possibility of bleeding in the area of the operation are also conceivable, wound healing disturbances or infections can never be ruled out in the area of the operation.
Depending on the location of the operation, injuries in the vicinity of the hip joint, such as injuries to the sciatic nerve or femoral nerve, can never be ruled out. Due to this specific intervention, a change in leg length may occur under certain circumstances, and bone tears or even fractures cannot be ruled out during the operation. The possible complications mentioned as examples in this section fall under the so-called intervention-specific complications.
Both forms of complications are listed here as examples only. The list does not claim to be complete. There are various scientific studies that investigate endoprosthetic hip joint surgery and possible complications.
The rate of complications can vary considerably. Looking at these studies, between 3 and 30% of all endoprosthetic hip operations result in the occurrence of complications, depending on the study. Not only the complication rate varies, but also the type of complication.
This is what the occurrence of one is called. The occurrence of a urinary tract infection (cystitis) was recorded relatively frequently, which is due to the fact that with increasing age the probability increases that a urinary catheter must be inserted after the operation. Below you will find the percentage distribution of the respective complications, some of which have a different percentage distribution due to the different studies.
While the above-mentioned studies also include patients whose hip joint was treated for coxarthrosis, a small national study only examined such patients. It was shown that patients whose hip joint was replaced due to such hip arthrosis-coxarthrosis have a lower complication rate. In comparison to the above-mentioned studies, the complication rate was about 8%.
The complication rates, including their percentage distribution, are listed below. The data refer to the study and give no indication of possible individual complications.
- Wound infection
- Thrombosis
- Pulmonary embolism or
- Inflammation of the adjacent bone tissue
- Urinary tract infectionUrinary bladder infection (In about 2 – 6% of cases, depending on the respective studies)
- Wound infections (In approximately 2 – 18 % of cases, depending on the respective studies, which sometimes also take minor infections into account (high rate), while these minor infections are not considered in other studies (low rate))
- Thrombosis (In about 0.5 – 5% of cases, depending on the respective studies)
- Pulmonary embolism (In about 1 – 3% of cases, depending on the respective studies))
- Inflammation of bone tissue (In about 0.2 – 4 % of all cases, depending on the respective studies)
- Thrombosis (in about 2% of all cases)
- Heart problems (in about 2% of all cases)
- Wound healing disorder (in about 1% of all cases)
- InfectionsProblems in the kidney and urinary tract (In about 1% of all cases)
- Surgery specific complications (In less than 1% of all cases: fractures/tears or damage to the sciatic nerve in about 0.5% of all cases; displacement of the replaced
- Hip joint in about 0.6% of all cases)
These complications do not give any indication of long-term complications.
These complications include, for example, so-called non-inflammatory (aseptic) prosthesis loosening, which often occurs several years after the operation. There are various reasons for such a loosening of the hip prosthesis, but the most important trigger is the harmful influence of so-called abrasion products of the prosthesis. As research is trying to find materials that do not rub off as much, it can be assumed that the influencing factor here will continue to decrease.
It can already be seen that modern materials such as polyethylene or ceramic sliding or metal sliding pairs minimize the influencing factor. Such a form of prosthesis loosening is always accompanied by severe pain and can even lead to functional disorders. In such cases the hip prosthesis is usually changed.
In general, it should be remembered that a prosthesis has a certain lifetime and that due to the unavoidable material aging process, a change of prosthesis may become necessary at an average prosthesis age of about 15 years. Since particularly young and athletically active people are considered a so-called “risk group” for a prosthesis loosening, this explains the reason why the advantages and disadvantages of an artificial hip joint should be carefully weighed against each other, especially in this patient group. Of course there are other “risk factors” for the possibility of prosthesis loosening.
For example, obesity is certainly one of them, since the new hip joint is immediately demanded a great deal from the patient in this individual case. Periarticular calcification (heterotopic ossification) is a special form of complication in hip endoprosthetics. It is a calcification of the soft tissue (muscles) that occurs after a few weeks or months after the operation.
These calcifications are new bone formations in the vicinity of the operated hip joint, which – depending on the individual case – can lead to severe pain or even restricted mobility, which the operation was intended to eliminate. It has been found that these periarticular ossifications (heterotopic ossification) can be prevented by the administration of an anti-rheumatic drug, usually indomethacin, dicolofenac or ibuprofen. Alternatively, it is possible to treat the hip joint with a single hip joint irradiation.
The dose of 7 Gy has proven to be effective. The radiation can be used prophylactically, but it can also be used if calcifications have already occurred. Irradiation can also be considered prophylactically, especially if the patient is classified as a so-called “risk patient” with regard to the occurrence of periarticular ossification.
This includes, for example, patients who already showed such a form of calcification after a previous operation or patients who suffered from a particularly severe restriction of movement before the operation (e.g. Bechterew’s disease). Patients with extensive tissue damage are also considered to be so-called “risk patients”. If prophylaxis is taken, the risk can be considerably reduced. The literature describes a reduction of the risk from about 80 to up to 10 percent.
- Non-inflammatory (aseptic) prosthesis loosening
- Periarticular calcification (heterotopic ossification)
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