A hip prosthesis may need to be replaced for various reasons. Replacing a hip prosthesis is more complex and demanding than its initial implantation. You can find further information and selected hip prosthesis replacement specialists and centers here.
Various reasons may make it necessary to replace the artificial hip joint. The most common reason for replacement surgery is loosening of the prosthesis . A distinction is made between aseptic (non-infectious) loosening and septic (infectious) loosening.
Other reasons for a replacement operation are
Septic loosening of the hip prosthesis, which occurs as a result of a bacterial infection of the hip prosthesis, is less common.
An early infection can occur due to contamination during or shortly after the initial implantation. This can be caused by the migration of skin germs via the wound; direct contamination during the initial procedure is also possible.
Germ colonization via the bloodstream is particularly common in the presence of serious pre-existing conditions such as diabetes.
The more common late infections on an endoprosthesis usually occur via colonization of the implant via the bloodstream. Even long and well-functioning endoprostheses can suddenly become loose due to a bacterial infection.
New examination methods show an increase in the proportion of septic-related loosening of endoprostheses. For example, removed prostheses are examined using ultrasound.
X-ray image of an implanted hip endoprosthesis © SOPONE | AdobeStock
Aseptic loosening of the hip prosthesis occurs more frequently. Sooner or later, it affects every hip prosthesis, regardless of where it is implanted. It is favored by
Over the years, tiny abrasion particles form between the artificial joint ball and the socket. They can cause inflammation in the tissue and thus loosen the hip prosthesis.
Poor handling of the artificial hip joint is rarely the sole cause of hip prosthesis loosening. Nevertheless, after the initial implantation, heavy joint loads (including overweight) should be avoided. Regular monitoring of the prosthesis by means of X-ray examinations is also recommended.
There is an increased risk of prosthesis infection, especially in patients who
in their medical history. Bacterial sources of infection lead to a high risk of infection of the implant. These include, among others
For this reason, early antibiotic therapy is now recommended for patients with inserted endoprostheses and a bacterial infection.
The symptoms of an acute hip prosthesis infection are
These symptoms may be absent in a late infection. An infection is usually accompanied by an increase in inflammation levels in the blood (leukocytosis, C-reactive protein, erythrocyte sedimentation rate).
Further diagnostic clarification is carried out in the form of
The treatment strategy depends on the type, duration and severity of the infection as well as the patient's physical constitution. It can include various measures, including
Decisive for the technique of the surgical procedure are
Instability that has existed since the operation is usually due to wear of the components or hip impingement. Hip impingement is the repeated impact of prosthesis components on each other or on the bone.
General risk factors for instabilities and dislocations (dislocations) are
The majority of joint instabilities require a surgical hip prosthesis replacement. The aim of the operation is to restore the soft tissue tension. Additional stability can be achieved through the use of suitable prosthesis components, such as
Periprosthetic fractures (bone fractures in the prosthesis region) can occur
occur during surgery.
When treating a fracture that has occurred, the aim is to restore the anatomical conditions and bony continuity.
If the prosthesis is firmly anchored and the possibility exists, this can be achieved using osteosynthesis procedures (plates or wires). Unstable prostheses often require the hip prosthesis to be changed to another system that bridges the fracture and allows force to be transferred beyond the fracture area.
Occasionally, in the case of extensive bony injuries, changing the prosthesis alone is not sufficient. Additional plates or wire bands must then be applied.
Over the course of a long life, several replacement operations on the same hip prosthesis may be necessary.
The survival time of replaced artificial hip joints is shorter than that of the primary prosthesis. Each time a hip prosthesis is replaced, it becomes more difficult to anchor the artificial hip joint firmly.
Depending on the
with a service life of 15 to 30 years.
In the event of complaints such as groin, thigh shaft or knee pain, the attending physician will clarify whether these are actually related to the endoprosthesis or are caused by other diseases. Other causes of the pain may include
A clinical examination by the doctor and laboratory and X-ray examinations are necessary to make a diagnosis. Occasionally, to confirm the diagnosis
may be necessary.
The doctor must assess the condition of the hip prosthesis anchorage. He will check whether the cup, the stem or both components are loose. It must also be clarified whether an infection is present and whether the stem or cup has migrated.
In rare cases, a reliable assessment is only possible during the operation, when the anchoring of the prosthesis can be checked on site.
Various procedures are available for replacing hip prostheses.
As part of the replacement operation
can be replaced.
Components of a hip endoprosthesis © bht2000 | AdobeStock
In the event of an infection, the artificial hip joint can be replaced in one or two sessions.
If a two-stage replacement is required, there may be several weeks or even years between the two sessions. In the first session, the prosthesis affected by bacteria is removed, the tissue is cleaned and a placeholder or antibiotic carrier is inserted.
This is replaced with the final hip prosthesis in the second operation.
A hip prosthesis replacement operation is not always necessary. Some complaints can (initially) also be treated conservatively.
Once the decision has been made to replace the artificial hip joint, the surgical procedure must be determined. This depends, for example, on
In addition to the revision procedure, the timing of the hip prosthesis replacement operation must be considered. In the case of an acute infection or dislocation of the prosthesis, surgery should be performed very soon.
The procedure for hip prosthesis replacement surgery also depends on how the first implant was inserted. If the first hip prosthesis is cemented in place, the cement often has to be removed completely.
Here and generally when removing the hip prosthesis from the bone, it is important to preserve as much intact tissue and bone material as possible.
Due to the destruction of bone by the loose prosthesis and cement, the risk of bone fractures is significantly higher during replacement surgery than during initial implantation.
The doctor decides on a case-by-case basis whether the new hip prosthesis should be cemented or inserted without cement.
Replacement surgery of the hip prosthesis takes longer than the initial implantation of the artificial hip joint.
It is also more complicated, as there is greater damage to the bone substance, among other things. Bone defects must be treated with the patient's own bone or donor bone and special implants.
The current standard in arthroplasty includes
As a result, the rate of infections during the implantation of hip endoprostheses has fallen significantly over the last few decades. If an infection does occur, the prognosis is better than it was a few decades ago.
Hip prosthesis replacement surgery is performed by a specialist in orthopaedics and trauma surgery or a specialist in orthopaedics.
A maximum care endoprosthesis center usually specializes in such operations.
The Leading Medicine Guide's quality assurance is ensured by the following acceptance prerequisites.
