Even though hip prostheses can last for 25 years or more, their durability is limited. Over time, the prosthesis may no longer be firmly anchored. This leads to hip prosthesis loosening.
You can find all the information and selected specialists for hip prosthesis loosening here.
Around 240,000 artificial hip joints (also known as hip endoprostheses or hip TEP) were implanted in Germany in 2019. With today's techniques and materials, these artificial hip joints usually last 25 years or longer. However, this also means that the durability of hip prostheses is limited.
For example, increasing wear between the components involved in the artificial hip joint causes the implant to loosen. This means that the hip prosthesis is no longer firmly anchored in the bone. The medical profession then speaks of hip prosthesis loosening. If the hip implant loosens within the first five to ten years, it is a case of early loosening of the hip joint endoprosthesis.
An artificial hip joint does not last forever.
The reasons why an implanted hip joint loosens can vary. Doctors distinguish between two basic forms of prosthesis loosening:
Pain is a typical symptom of hip prosthesis loosening. Depending on the extent of the loosening and the loosened prosthesis component, the pain occurs in different places:
Other symptoms or indications of a loosening of the artificial hip joint are
If the leghas shortened, it is probably already at an advanced stage of loosening. In this case, the hip socket has moved out of its original position or bone fractures have occurred in the area of the hip socket, leading to a "compression" of the leg.
If the cause of the hip prosthesis loosening is a bacterial infection, typical signs of inflammation or infection may occur:
A bacterial infection is more likely to be the cause of hip prosthesis loosening in the first months to years after the hip operation. Later on, septic hip prosthesis loosening is rare. At later stages, factors such as
as the cause of prosthesis loosening.
What are the causes of septic hip prosthesis loosening?
In around one to two percent of patients, bacteria are introduced during hip surgery. These colonize around the prosthesis, multiply and form a biofilm. This in turn prevents the implant from growing properly into the bone. The result is loosening of the hip prosthesis.
All previous illnesses, therapies or circumstances that are associated with a poorer immune defense are considered risk factors for septic prosthesis loosening. These are, for example
If bacteria are introduced during hip surgery, this can lead to septic hip prosthesis loosening.What are the causes of aseptic hip prosthesis loosening?
In an artificial hip joint, the individual components are not protected from wear by a layer of cartilage as in a healthy joint. The permanent sliding of the artificial surfaces against each other results in abrasion of the surface material. The particles now in the hip joint in turn lead directly or indirectly to bone resorption via an inflammatory reaction. This then leads to a loosened hip endoprosthesis.
Other factors that have a negative influence on the durability of a hip prosthesis are
As part of the anamnesis, i.e. the patient interview, the focus is on the complaints described by the patient and the medical history. This includes, for example, the time of hip replacement surgery, previous illnesses or traumatic events.
The type and localization of the pain provide an initial indication of possible prosthesis loosening.
As part of the clinical examination, the doctor will try to find out by
the leg or hip to trigger the pain.
He will also test the mobility in the hip joint and pay attention to how you walk and whether your gait is normal.
If it is suspected that the hip endoprosthesis has loosened, an X-ray of the hip will be taken. This will also show the complete endoprosthesis. The signs of loosening cannot always be perfectly recognized in the X-ray image. It is therefore useful to compare the image with an X-ray taken immediately after the hip prosthesis was implanted. In unclear cases or when special questions arise, scintigraphic
are used.
If a septic cause is suspected, the inflammation parameters (erythrocyte sedimentation rate, leukocytes, C-reactive protein) are determined in a blood sample. In addition, the joint is punctured with a long hollow needle and the joint punctate is then examined for bacteria.
Loosened hip endoprostheses are first surgically removed as part of a so-called replacement operation and replaced with a new artificial hip joint. Orthopaedic surgeons and trauma surgeons with extensive experience in hip endoprosthetics are considered experts in hip revision (revision surgery).
The exact procedure for a revision operation depends on whether the cause is bacterial or non-bacterial.
In the case of aseptic prosthesis loosening, the hip endoprosthesis is usually removed in a single-stage replacement operation(explantation) and the new endoprosthesis(revision endoprosthesis) is inserted immediately afterwards.
Most septic prosthesis loosening, on the other hand, must be treated in a two-stage replacement operation. In this case, the revision endoprosthesis is only inserted after removal of the infected tissue and antibiotic therapy during a second operation. The bone restoration and antibiotic therapy can take several weeks. They may have to be repeated in order to completely stop the infection.
The insertion of a revision endoprosthesis after aseptic prosthesis loosening is basically the same as a normal hip endoprosthesis operation. The prognosis therefore depends on the existing risk factors. The material properties of today's artificial hip joints have been significantly improved. In principle, it can be assumed that hip endoprostheses will last longer than they did 20 or 30 years ago.
In contrast, the prognosis after surgical treatment of septic prosthesis loosening depends crucially on the course of the infection. This is a lengthy process that can involve repeated operations and rehabilitation.
The likelihood of hip prosthesis loosening also depends on the expertise of the surgeon. This was the result of a study by the Scientific Institute of the AOK.
You should therefore only have your artificial hip joint fitted by absolute specialists in hip endoprosthetic surgery. This way, you can reduce the risk of the prosthesis loosening later on right from the start.
As already mentioned, being very overweight is a possible risk factor for the endoprosthesis loosening. You should therefore try to avoid excessive weight gain or, if you are very overweight, reduce your body weight. You should also avoid all activities and sports that put excessive strain on the hip joint.
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