Endoprosthetics - Medical specialists

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Endoprosthetics - Further information

Background information on endoprosthetics

An endoprosthetic is a prosthesis that is implanted. This makes it possible to reconstruct a diseased or injured body part. This restores the compromised part’s function and allows continued mobility for the patient.

An endoprosthesis is used as joint replacement if the natural joint is no longer entirely functional. This may be the case, for example, in the presence of arthrosis. This means the cartilage of the joint has been worn off. Then the joint head can no longer move freely in the socket. In addition, the cartilage may ossify, leading to serious pain.

An endoprosthesis can be used as a joint replacement in different parts of the body. It may replace a shoulder, elbow or ankle joint. The most frequently used prosthesis, however, is the so-called artificial hip or knee. In Germany alone, some 150,000 knee TEPs are performed annually.

The word knee-TEP stands for total endoprosthesis of the knee joint. This means that not only part of the natural joint is replaced but all components of the affected joint. This includes the joint head and the joint socket.

Preparing for an endoprosthesis

Endoprosthesis is the last option that can be used in situations of serious pain. This is because the placement of an endoprosthesis is a complicated operative procedure that cannot be reversed.

The use of an endoprosthesis must be able to partially or completely replace a joint. It requires both artificial parts with a long lifespan and secure placement within and by the structures that are retained. This includes both the ligaments and the adjacent bone. For the placement of a total endoprosthesis, the bones are cored so that the shaft of the artificial joint can be placed there and attached securely. In most cases the artificial joint is fastened in the bone using bone cement. If the endoprosthesis is secured in this way, however, it can no longer be replaced after the conclusion of its lifespan.

An endoprosthesis is often preceded by many years of wear of the joint that leads to severe pain. The pain occurs because the natural joint no longer functions properly and the joint head cannot move smoothly in the joint socket. In addition, a breakdown of joint lubrication can lead to the cartilage ossifying, cracking or becoming uneven. This situation intensifies the pain.

The techniques of endoprosthetics

The endoprosthesis can be used as partial replacement of a joint or replacement of an entire joint. This is then called a TEP, a total endoprosthesis. Depending on which part of a joint is damaged or the cause of the situation, the physician decides what type of endoprosthesis to use.

The name of the partial prosthesis already says that it is only replacing part of the joint. Here, for example, a replacement joint head replaces the natural one and the bone, the ligaments and parts of the socket can be retained.

On complete endoprosthesis, however, the entire joint with all its components is replaced. This includes both the socket and the joint head. Both are connected securely and stably with the existing bone, so that the natural joint has been entirely replaced and can fulfil its function again.

Endoprosthesis as such, for example the hip-TEP, consists of two parts that imitate the joint head and the socket. The spherical joint head is then at the upper end of a sort of stick that is secured inside the neck of the femur bone. So that the head can move freely in the artificial joint socket, this is covered with a special material.

Surgery for placement of an endoprosthesis

The placement of an artificial joint is a serious and time-consuming operation that requires both a well trained OR team and an experienced surgeon that can also deal competently and securely with unexpected occurrences. Only then can a good result be guaranteed for the patient. In addition, experts in endoprosthetics work in a clinic with state-of-the-art equipment so that the best possible treatment for the patient is guaranteed before, during and after surgery.

The operation to place an endoprosthesis must take place under general anaesthesia, so that preoperative studies of the cardiovascular system and a detailed discussion with an anaesthesiologist is necessary. Only in this way can it be assured that the OR team can deal competently with any events that may occur during the operation.

During the surgery and after the placement of an endoprosthesis x-rays are taken through which the correct positioning of the endoprosthesis is monitored. In addition, the patient goes through the postoperative follow-up that is standard after surgery under general anaesthesia. Monitoring of the cardiovascular system and control of wound healing. In addition, the patient undergoes a rehabilitation programme tailored for him and his new joint.

Treatment after endoprosthesis placement

The implanted endoprosthesis replaces a joint. It must be fully functional during all of the everyday activities of the patient. The patient must become accustomed to it, and the musculature and the prosthesis themselves must also adjust to the endoprosthesis. The interaction of these components is new for the patient, so it is entirely unfamiliar.

With the aid of rehabilitation after the placement of the endoprosthesis that also, for example, includes physiotherapy, the patient learns to securely and comfortably use the new artificial joint during his everyday activities.

The rehabilitation measures (Rehabilitation) give the muscles back their strength after surgery. In addition, the muscle and the endoprosthesis can be adapted to the new mechanical stress.

On the basis of the artificial joint the patient can now once again carry out his daily activities normally and again effect movements that he had been avoiding due to his disease. This is a physical change that requires slow but steady training after surgery.

So the placement of an endoprosthesis must be supported by rehabilitation measures, such as for example physiotherapy. If after placement of the endoprosthesis sports and movement become daily activities again, the musculature strengthens as the joint is thus spared. Through this protection, the functionality of all the joints can be maintained.

These days the lifespan of a total endoprosthesis is ten to fifteen years.

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