The surgery
The extent of the operation to insert a hip prosthesis depends on whether a partial or total endoprosthesis is inserted, i.e. whether the hip joint is only partially or completely replaced by artificial prosthesis parts. The classical surgical technique is distinguished from the minimally invasive access technique, whereby the latter is preferred due to the protection of the tissue and the better, faster and less complicated healing process. As a rule, the operation is performed under general anesthesia, after a preliminary surgical and anesthesia explanation discussion with the respective specialists.
With the minimally invasive method, the skin incision of about 8-10cm in length is made in the lateral area of the hip (antero-lateral access) above the large rolling hill, so that the surgeon can then visualize the hip joint without having to cut through muscles or tendons. A posterior minimally invasive approach through the gluteal muscles is also possible (postero-lateral approach).In contrast, in the classic access method, muscles and tendons were or are severed, which are then sewn back together again and have to heal. Next, the joint capsule and the femoral head are removed and the acetabulum is milled out so that the correct size for the artificial prosthetic cup used is produced.
Once this is done, the acetabular prosthesis part and the corresponding inlay are inserted. The femur is then hollowed out a little and milled out until the desired prosthesis stem diameter is reached. The shaft prosthesis is then inserted and a test femoral head is placed.
The femoral head is placed in the socket with this and the joint is thus “assembled” on a trial basis. If everything fits perfectly, the test femoral head is replaced by the original artificial femoral head. Finally, a Redon drain is placed in the wound, which allows blood and wound water to drain out of the wound in the following days.
The wound is closed and the skin is sealed with either a suture or staple suture. In general, the prosthesis parts can be inserted without cement or the prosthesis parts are cemented into the bone. This depends in particular on the nature or condition of the bone parts carrying the prosthesis.
