Hip surgery: Information & specialists for hip surgery

The hip joint consists of the socket (acetabulum) and the head of the thigh bone (femur). The joint allows the leg to rotate in all directions.

An operation on the hip is necessary if

• the patient suffers restricted movement,
• has pain and
• conservative treatment methods do not improve health.

A very common hip operation is the insertion of an artificial hip joint (hip prosthesis). For this reason, we will focus on hip endoprosthetics in this text. The artificial hip joint later assumes the same functions that the natural hip joint had previously.

In some cases, a joint replacement is not necessary: In this case, it is sufficient to remove cartilage parts and other troublesome tissue to restore freedom from pain.

Disease patterns that make hip surgery necessary

The most common reason for the use of an artificial hip joint is very advanced osteoarthritis of the hip joint(coxarthrosis). The mostly age-related wear and tear of the joint cartilage usually means that the natural hip joint can no longer be repaired. Therefore, the use of an artificial hip is necessary.

Other reasons for hip operations are

• a congenital hip dysplasia: Serious deformities of the hip joint that cannot be treated conservatively must be corrected surgically. In babies with this malformation, the femoral head sits incorrectly in the joint socket so that both joint parts collide. As a result, the children have legs of different lengths and often an asymmetrical buttock crease.
• a hip joint fracture, for example due to a serious accident.
• hip joint growths
• Inflammatory(arthritic) changes in the hip

What procedures are available for hip surgery?

The surgeon either replaces both hip joint parts with a total endoprosthesis (TEP), also known as an artificial hip joint. If the damage is less severe, only part of the joint needs to be replaced with a so-called partial endoprosthesis.

Which prosthesis is ultimately used for a patient depends on

• the age of the patient,
• their level of activity,
• their body weight and
• their bone density

density. The artificial hip joints and partial prostheses implanted today are normally intended for use for 15 to 20 years. After that, they must be replaced as part of a hip prosthesis replacement.

A total hip endoprosthesis replaces the joint socket and the femoral head © SciePro | AdobeStock

Before the hip operation, the doctor examines the patient using imaging techniques. An X-ray examination is usually used. This enables the doctor to determine whether a hip prosthesis is necessary. If so, he can assess which prosthesis promises the best success and which type of anchoring (screwing on, cementing in) is suitable.

The surgeon uses the X-ray image to create a computer-aided planning sketch. In this way, he can optimally adjust the size and position of the prosthetic components to the patient. This procedure serves to minimize possible complications during the surgical intervention.

For hip operations, hip surgery specialists use the conventional or minimally invasive procedure.

Conventional surgical technique

A conventional surgical technique is an operation using a long tissue incision. This gives the surgeon a direct view of the surgical site and allows them to work on the exposed hip bone.

This conventional surgical technique and the insertion of the hip TEP is usually used in cases of very advanced joint degeneration.

The procedure is performed under general anesthesia or spinal anesthesia (anesthetic injection into the spinal canal).

The surgeon opens the hip joint completely and removes worn bone material. He then prepares the hip bone for the prosthesis: He mills off the cartilage surfaces of the joint socket, opens the hip stem and processes it with special rasps. He then screws or cements the artificial hip joint into place.

The artificial hip is then tested for mobility and functionality. If everything goes according to plan, the surgeon closes the wound and applies a compression bandage.

Minimally invasive hip surgery

Modern minimally invasive hip surgery is much more tissue-friendly. The surgeon makes smaller incisions and implants the endoprosthesis through a naturally existing gap in the muscle. This means he does not have to cut the hip muscles. It is also gentler on the tendons and nerves.

Rehabilitation after hip surgery therefore takes less time. Complications during the surgical procedure are virtually impossible, even in patients who are very overweight. There is also less blood loss during the operation.

The surgical scars are shorter and less noticeable than after conventional surgery.

The minimally invasive method is suitable for patients of all ages. However, it cannot be used for every hip disorder.

Arthroscopic hip surgery

Arthroscopy can be used for mild osteoarthritis symptoms. In this

• the surgeon smoothes the hip joint cartilage affected by wear and tear,
• removes any existing bone growths and
• and thus improves the patient's mobility.

In this way, it may be possible to halt or slow down the progression of coxarthrosis.

How long does a hip operation take?

The duration of a hip operation depends on the chosen surgical technique and other factors. If the surgeon uses the conventional procedure, the maximum duration is two hours - unless there are complications.

Minimally invasive hip operations take 50 to 70 minutes.

Risks and complications of hip surgery

Like other surgical procedures, hip operations are also associated with risks. For example, every operation can lead to wound infections caused by germs or healing disorders.

Venous thrombosis can occur during the insertion of an artificial hip joint. This is defined by doctors as the formation of a blood clot. This can block important blood vessels and cause a life-threatening embolism. To prevent this from happening, the patient is given blood-thinning medication as a preventative measure.

The special surgical risks include

• hip dislocation (dislocation of the hip joint): this complication occurs if the surgeon does not insert the endoprosthesis accurately enough.
• the bones grow together incorrectly: If the patient does not move enough immediately after the hip operation, adhesions of the joint and adhesions of the tissue are sometimes the result.
• periarticular ossification (calcification in the tissue near the surgical site): Calcium deposits in the neighboring muscle tissue and causes mobility restrictions and pain. A second operation is necessary.

The most common complications of hip surgery include

• injury to neighboring nerves (sciatic nerve or femoral nerve)
• Bone fractures: If the femur and acetabulum break, additional supportive measures are necessary.